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http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Cranial_Vault_Configuration_is_an_Integral.1.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00001http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Expanding_the_Phenotypic_Expression_of_Sonic.2.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00002http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Ethical_Considerations_for_Surgeons.3.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00003http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Management_of_Craniofacial_Chondroid_Tumors.4.aspx
Background: Craniofacial chondroid tumors (CFCTs) constitute less than 1% of all intracranial mass lesions. No protocol for evaluation and management of CFCTs is developed at the moment.
Materials and methods: We analyzed 51 patients with CFCTs operated on in Burdenko Neurosurgical Institute from 1980 until 2012, which included chondroma (15), chondroblastoma (3), chondromyxoid fibroma (11), and chondrosarcoma (22). Age varied from 2 to 76 years (mean, 40 y); the series included 23 women and 28 men. All tumors were divided into 4 groups: midline unilateral (8),midline bilateral (21), anterolateral (19), and lateral (3). This division was based on differences in surgical approaches (P = 0.009).
Results: All patients underwent surgical treatment. Complete removal was achieved in 20; subtotal, in 21; and partial, in 10. Two patients died, and early complicationswere observed in 10 cases. Early outcomes correlated with the benign nature of the tumors (P = 0.002). Follow-up data were available in 22 patients. Fifteen of 51 patients were reoperated on because of recurrence (a total of 43 reoperations were performed). The mean recurrence-free period was 45 months. In 3 patients, the tumor metastasized, and malignant transformation was observed in 3 cases. Sixteen patients received postoperative radiation therapy. Delayed sequelae occurred in 5 observations, and 5 patients died during long-term follow-up. Three-year survival in benign and malignant tumors was 87.5% and 55.6%, respectively, and 5-year survival was 83.3% and 40.0%, respectively.
Conclusion: Surgical resection is the mainstay in treatment of both benign and malignant craniofacial tumors, and adjuvant radiation therapy is mandatory in malignant lesions; however, it should be avoided in benign lesions.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00004http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Long_Term_Morphological_Outcomes_in_Nonsyndromic.5.aspx
Abstract: Correction of scaphocephaly is one of the principle goals of surgery in sagittal craniosynostosis. Reported relapse in head shape after surgery and continued head growth into late adolescence underscores the need for long-term outcomes to be considered when comparing between different surgical approaches in this condition; yet there are relatively few reports of results to 5 years and beyond in the literature. Therefore, a retrospective review was performed of the anthropometric data of 224 patients with sagittal craniosynostosis who underwent primary surgery between 1994 and 2012. During this period, patients underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure. Sixty-two patients were treated by MSC and followed up for a mean of 44 months. One hundred sixty-two patients had CR, with follow-up for a mean of 45 months. Overall, 90 patients were seen up to 5 years, and 47 patients to 9 years or more after surgery. The cephalic index (CI) of MSC-treated patients improved from a mean of 67.0 to 72.7, with 31% achieving a CI greater than 75 at one year. Calvarial remodeling was significantly more effective at correcting the scaphocephalic deformity. Patients treated with CR improved from a mean CI of 66.7 to 76.1. Sixty-two percent of the patients achieved a CI greater than 75. In both groups, outcomes were stable throughout follow-up with no significant relapse up to 14 years after surgery.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00005http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Systematic_Review_of_Interventions_for_Minimizing.6.aspx
Background: Surgery for craniosynostosis is associated with the potential for significant blood loss. Multiple technologies have been introduced to reduce the volume of blood transfused. These are preoperative autologous donation; preoperative erythropoietin; intraoperative cell salvage (CS); acute normovolemic hemodilution; antifibrinolytic drugs such as tranexamic acid, ε-aminocaproic acid, and aprotinin; fibrin sealants or fibrin glue; and postoperative drain reinfusion.
Methods: All comparative studies with a treatment group and a control group were considered. There was a range of different study types from randomized controlled trials to case series with historic controls. These were intervention versus no intervention or a comparison of 2 interventions. Studies were identified by searching Cochrane CENTRAL, MEDLINE, and EMBASE; manufacturer’s Web sites; and bibliographies of relevant published articles. The primary outcome measures were the number of allogeneic blood donor exposures, the volume of allogeneic blood transfused, and the postoperative hemoglobin or hematocrit levels.
Results: A total of 696 studies were identified. After removal of duplicates and after exclusion criteria were applied, there were 18 studies to be included. Fourteen were case series with controls and 4 were randomized controlled trials.
Conclusions: The production of high-quality evidence on the interventions to minimize blood loss and transfusion in children undergoing surgery for craniosynostosis is difficult. Most of the literature is nonrandomized and noncomparative. Several areas remain unaddressed. Erythropoietin and tranexamic acid are comparatively well studied; CS, acute normovolemic hemodilution, and aprotinin are less so. There is only 1 comparative study on the use of fibrin glue and drain reinfusion, with no studies on preoperative autologous donation and [Latin Small Letter Open E]-aminocaproic acid. Tranexamic acid is clinically effective in reducing allogeneic blood transfusion. There is some evidence that CS and erythropoietin may be clinically effective. None of the interventions studied are shown to be cost-effective because of lack of evidence.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00006http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Aesthetic_Occiput_Augmentation_Using.7.aspx
Abstract: Cranioplasty for only aesthetic reasons has not been commonly performed to date. However, recently there has been a new focus by the public on a more aesthetically pleasing head shape with frequent patient requests for purely aesthetic contouring of the occiput, an important definer of cosmetic head shape. For example, in Asia, where the normal cranial shape is mesocephalic or brachycephalic and often with a planar occiput, requests for its aesthetic correction are increasingly common. Accordingly, the author developed a minimally invasive occiput augmentation using methylmethacrylate. In this study, the indications for aesthetic occiput contouring were planar occiput, left-right asymmetric occiput, and grooved occiput. Under local anesthesia, soft methylmethacrylate is subperiosteally inserted through a small incision (about 5-cm length), manually and precisely contoured in situ through the scalp to the desired occipital shape. All is performed as an outpatient procedure, and a quick recovery is the case. Between March 2007 and October 2013, 959 patients received such aesthetic occiput augmentation. The mean follow-up period was 49 months (range, 3–84 months). Nearly all patients were satisfied with the outcome, and complications were very rare. Only 5 patients (0.5%) needed additional corrective procedures. The author has concluded that aesthetic occiput augmentation using methylmethacrylate yields consistent, predictable, and satisfactory results. Additional long-term follow-up is required for a final conclusion, however.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00007http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Long_term_Follow_up_Study_of_Radial_Forearm_Free.8.aspx
Abstract: Previous studies on postoperative long-term results in patients who underwent reconstructive free flap transfer following hemiglossectomy had some issues, including the heterogeneity of the patient population and the observation period. The present study aimed to evaluate changes of reconstructed tongues in patients who underwent radial forearm free flap (RFFF) after hemiglossectomy with long-term follow-up. We enrolled 23 patients who underwent RFFF after hemiglossectomy with a postoperative follow-up of 5 years or more. Postoperative status (eating, speech, sensation function) was assessed by concise medical inquiries. Morphological changes of flaps were evaluated by reviewing clinical photographs. Hemiglossectomy involving the base of the tongue was performed in 4 cases (17.4%) and was limited to the mobile tongue in 19 cases (82.6%). The mean follow-up was 85.4 months (range, 60–122 months). All patients experienced gradually improved postoperative status. The most significant improvement was found between 1 and 5 years after surgery (P = 0.007), but not between 1 and 3 years (P = 0.075) or between 3 and 5 years (P = 0.530). In almost all of the flaps, there were few morphological changes throughout the follow-up period. Postoperative status in patients who underwent reconstructive RFFF following hemiglossectomy improved sequentially.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00008http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Estimation_of_Eighth_Costal_Cartilage_in_Surgical.9.aspx
Abstract: There is controversy over the optimal timing of microtia reconstruction. The eighth costal cartilage, which is used to shape the helix framework, can be one of the key factors determining surgical timing of microtia reconstruction. Nevertheless, it is difficult to predict the length of the eighth costal cartilage preoperatively. The aim of the present study was to suggest clinical predictors of the length of the eighth cartilage by assessing the correlation between the actual length of the eighth cartilage and preoperative measurements of the cartilage length using three-dimensional rib-cage computed tomography (3D rib-cage CT). A retrospective analysis was performed on a total of 97 patients who underwent preoperative 3D rib-cage CT and auricular reconstruction using a rib cartilage graft between January 2010 and February 2013. The length of the eighth costal cartilage on 3D rib-cage CT was measured preoperatively, and the length of the harvested eighth rib cartilage was measured intraoperatively. We analyzed the association between the preoperative and intraoperative measured length of the eighth rib, with patient age, height, weight, and body mass index. Preoperative measurement using 3D rib-cage CT showed a high correlation with actual cartilage length. Height and weight correlated more strongly with length than with age. This study describes the usefulness of 3D rib-cage CT for preoperative measurement of the length of the eighth costal cartilage. The measurement of the eighth rib cartilage on 3D rib-cage CT could be a useful aid for reconstructive surgeons in planning microtia reconstruction.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00009http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Uncinatotomy___Performing_Endoscopic_Sinus_Surgery.10.aspx
Background: The results of endoscopic sinus surgery performed for chronic rhinosinusitis are controversial. For a better surgical outcome, different surgical techniques involving an uncinectomy as the primary step of the operation have been proposed. The surgery should resolve the pathophysiologic problems caused by the disease and preserve the normal anatomy and physiology. We developed a technique to remove the pathology localized to isolated maxillary and anterior ethmoid cells, without excising the uncinate process. The infundibular area was exposed with medialization of the uncinate with a bipedicle flap prepared 1.5 cm from the insertion of the uncinate to the nasal wall, and then the sinus pathology was removed. At the end of the surgery, the uncinate was returned to its original position.
Methods: We performed this new technique to 3 patients and evaluated postoperative results.
Results: Primary disease was eradicated, and no complication was noted.
Conclusions: With this technique, it is possible to perform all steps of sinus surgery without excising any anatomic structure.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00010http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Thermal_Shell_Fragment_Craniofacial_Injury__.11.aspx
Abstract: This article aims to bring attention to unique risks and burns by thermal shell fragment craniofacial soft tissue injury. Hot shrapnel may inflict burns to major vessel walls and lead to life-threatening hemorrhaging or death, which adds a new challenge for craniofacial surgeons. Morbidity of thermal deep tissue may lead to deep tissue necrosis and infection.
Thermal energy (TE) physics, biophysics, and pathophysiological effects relate directly to the amount of heat generated from shell casing detonation, which transfers to skin, deep tissue, as well as brain and leads to life-threatening burning of organs; this is different from shrapnel kinetic energy injury.
The unprecedented increase in using a large range of explosives and high-heat thermobaric weapons contributes to the superfluous and unnecessary suffering caused by thermal injury wounds.
Surgeons and medics should recognize that a surprising amount of TE can be found in an explosion or detonation of a steel-encased explosive, resulting in TEs ranging from 400 F up to 1000 F.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00011http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Direct_Brain_Recordings_Reveal_Impaired_Neural.12.aspx
Background: Patients with single-suture craniosynostosis (SSC) are at an elevated risk for long-term learning disabilities. Such adverse outcomes indicate that the early development of neural processing in SSC may be abnormal. At present, however, the precise functional derangements of the developing brain remain largely unknown. Event-related potentials (ERPs) are a form of noninvasive neuroimaging that provide direct measurements of cortical activity and have shown value in predicting long-term cognitive functioning. The current study used ERPs to examine auditory processing in infants with SSC to help clarify the developmental onset of delays in this population.
Methods: Fifteen infants with untreated SSC and 23 typically developing controls were evaluated. ERPs were recorded during the presentation of speech sounds. Analyses focused on the P150 and N450 components of auditory processing.
Results: Infants with SSC demonstrated attenuated P150 amplitudes relative to typically developing controls. No differences in the N450 component were identified between untreated SSC and controls.
Conclusions: Infants with untreated SSC demonstrate abnormal speech sound processing. Atypicalities are detectable as early as 6 months of age and may represent precursors to long-term language delay. Electrophysiological assessments provide a precise examination of neural processing in SSC and hold potential as a future modality to examine the effects of surgical treatment on brain development.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00012http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Craniofacial_Reconstruction_With_Poly_Methyl.13.aspx
Background: Secondary cranioplasty with customized craniofacial implants (CCIs) are often used to restore cerebral protection and reverse syndromes of the trephined, and for reconstruction of acquired cranial deformities. The 2 most widely used implant materials are polyetheretherketone and poly(methylmethacrylate) (PMMA). Previous series with CCIs report several major complications, including implant infection leading to removal, extended hospital stays, and surgical revisions. With this in mind, we chose to review our large case series of 22 consecutive PMMA CCI cranioplasties treated by a single craniofacial surgeon.
Methods: A cohort of 20 consecutive patients receiving 22 PMMA implants during a 2-year period was identified and outcomes reviewed. The mechanism of initial insult, time from craniectomy to cranioplasty, anesthesia time, major and minor postoperative complications, radiation history, and length of follow-up were statistically analyzed.
Results: There were no complications related to infection, hematoma/seroma, or cerebrospinal fluid leak (0/22, 0%). Two patients experienced major complications related to persistent temporal hollowing (PTH) following standard CCI cranioplasty, which required revision surgery with modified implants (2/22, 9%). One minor complication of self-resolving transient diplopia was noted (1/22, 5%).
Conclusions: In this consecutive series, PMMA CCIs were associated with a very low complication rate, suggesting that PMMA may be a preferred material for CCI fabrication. However, with 10% (2/20) of patients experiencing PTH and dissatisfaction related to asymmetry, future research must be directed at modifying CCI shape, to address the overlying soft-tissue deformity. If successful, this may increase patient satisfaction, prevent PTH, and avoid additional costs of revision surgery.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00013http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Assessment_of_Presurgical_Clefts_and_Predicted.14.aspx
Abstract: Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons’ assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non–NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00014http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Facial_Wound_Closure_in_Children_Using_a_7_0.15.aspx
Background: Management of pediatric facial wounds is more challenging compared to adults. Suture removal is difficult, and children are less likely to protect the suture line postoperatively. The purpose of this study was to determine the efficacy of a facial wound closure regimen designed to ensure the best possible outcome in the pediatric population.
Methods: Children 12 years or younger who had a skin lesion resected from the face between 2007 and 2013 were investigated. Patients who had their wound closed using 7-0 absorbable suture, glue, and tape were studied. Predictive variables included patient age, indication for the procedure, size of the excised lesion, and location of the repair. Outcome measures were infection, wound dehiscence, and scar appearance.
Results: Two-hundred sixty-one children were included (151 girls, 110 boys). The mean (SD) age was 4.0 years (3.3 y). Types of lesions that were excised were nevus (24.9%), cyst (22.2%), vascular anomaly (19.5%), pilomatrixoma (13.8%), accessory tragus (11.9%), scar (4.6%), or other (3.1%). The mean (SD) area of the resected specimen was 2.2 cm2 (3.9 cm2). The complication rate was 0.8% (infection, n = 1; dehiscence, n = 1). Four patients had an unfavorable appearing scar that widened (1.5%).
Discussion: A facial wound closure regimen using small absorbable sutures, glue, and tape optimizes outcomes in the pediatric population. Suture removal is not required, complications are rare, and scar appearance is excellent.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00015http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Ophthalmic_Findings_in_Children_With_Nonsyndromic.16.aspx
Abstract: The ocular and systemic abnormalities of nonsyndromic craniosynostosis are often considered to be less severe than those of syndromic craniosynostosis and are less well described. The purpose of this article was to describe the frequency and nature of ophthalmic abnormalities in children treated for nonsyndromic craniosynostosis by expansion cranioplasty. A retrospective review identified 88 consecutive children with nonsyndromic craniosynostosis who underwent expansion cranioplasty with distraction osteogenesis. Assessment of presence and type of strabismus, refractive error, and amblyopia before and 6 months after surgery was recorded. Children with a mean age of 24.4 months were treated for nonsyndromic craniosynostosis (27 with coronal and 61 with sagittal and/or lambdoid). One-fourth of the patients had a fixation preference. Significant refractive errors were found in 45 (51%) of the 88 patients: hyperopia in 27%, myopia in 5%, and astigmatism in 35%. Anisometropia was present in 20%. Of the 85 patients who completed orthoptic examination, 48 (56%) had strabismus: exodeviation in 26%, esodeviation in 14%, and vertical deviation in 5%. Fourteen patients (16%) had abnormal head posture. Significant refractive error and strabismus were more likely to occur in cases with coronal synostosis. The procedures used for cranial vault expansion improved the abnormal head posture but did not affect the refractive error or ocular misalignment. Of children with nonsyndromic craniosynostosis who need neurosurgical correction, more than half were found to have significant refractive error and strabismus. Our findings support the importance of ophthalmic evaluation in these children.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00016http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Evidence_of_Olfactory_Deficits_as_Part_of_the.17.aspx
Abstract: Improved understanding of the phenotypic spectrum associated with nonsyndromic orofacial clefting (OFC) has the potential to inform efforts to uncover the etiology of this complex trait. Prior studies report that individuals with OFC are characterized by impaired olfactory ability. In this study, we test whether olfactory dysfunction extends to the unaffected parents of children with OFC. The University of Pennsylvania Smell Identification Test was used to measure olfactory ability in a sample of 60 unaffected mothers and fathers with cleft-affected children. The proportion of deficit was compared with reference data obtained from published sex- and age-specific norms on more than 2700 individuals. The proportion of deficit was significantly higher in unaffected parents compared with baseline control subjects (41.7% vs 12.6%; P < 0.001). Of unaffected fathers, 41.7% displayed evidence of deficit compared with 15.1% of male control subjects (P = 0.001), whereas 41.7% of mothers exhibited deficits compared with 10.4% of female control subjects (P < 0.001). Olfactory deficits are present at a high proportion in the unaffected parents of individuals with OFC. This suggests that the deficits observed in affected cases may not simply be a secondary consequence of surgical repair and may instead be an informative phenotype reflecting underlying etiology.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00017http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Computed_Tomographic_Analysis_of_Frontal_Sinus.18.aspx
Objective: The objective of this study was to radiologically determine frontal sinus drainage pathway variations with respect to superior attachment of uncinate process (SAUP) and their effect on prevalence of frontal rhinosinusitis.
Design: This was a retrospective cohort study.
Methods: Computed tomography scans of the 919 frontal sinus sides of 460 patients (252 female, 208 male; mean age, 35.1 ± 10.5 years) who were candidates for endoscopic sinus surgery were evaluated retrospectively between August 2012 and January 2013 by 3 radiologists to determine the SAUP types and the presence of frontal rhinosinusitis.
Results: The frontal sinus outflow tract was localized medial to the SAUP in 651 frontal sinus sides and lateral to the SAUP in 268 sides. We determined 3 types (types 7, 8, and 9) of SAUP in addition to 6 types defined in literature. The most common type of SAUP was type 3 (n = 332, 36.1%) followed by type 2 (n = 256, 27.8%) and type 7 (n = 160, 17.4%). Of the evaluated sides, 316 (34.3%) had frontal rhinosinusitis. Frontal rhinosinusitis was more common in the sides where the frontal sinus outflow tract was localized medial to the SAUP than those localized lateral (37.2% vs 27.6%, P = 0.006).
Conclusions: Endoscopic approach to frontal recess usually requires uncinectomy, and it is necessary to know SAUP to prevent postoperative retained superior portion of the uncinate process. The location of frontal sinus outflow tract on the SAUP affects the prevalence of frontal rhinosinusitis as well. Frontal rhinosinusitis is significantly more common when the frontal sinus outflow tract was localized medial rather than lateral to the SAUP.
Level of evidence: 2b.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00018http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Feasibility_of_Purely_Endoscopic_Intramedullary.19.aspx
Abstract: The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00019http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/In_Search_of_the_Optimal_Processing_Technique_for.20.aspx
Objective: Unpredictability in graft retention remains a significant drawback of fat grafting. Processing of fat grafts has been the focus of several studies to improve graft survival. The objective of this study was to systematically review the outcomes of different fat graft processing techniques with the goal of (1) deriving clinically oriented insights and (2) identifying gaps in knowledge to stimulate future research.
Methods: PubMed, EMBASE, and Cochrane Databases were searched to identify studies that compared different fat graft processing techniques. Outcome measures of interest were any subjective or objective measures of fat graft survival or reports of adverse events.
Results: A total of 2056 abstracts were generated from the literature searches; 13 studies met the criteria for data extraction and analysis. Processing methods assessed included decantation, washing, gauze filtration, and centrifugation. Each processing method was found to be better than other methods, depending on the outcome measure used to study graft survival. As well, several studies found statistical equipoise in the outcome measures when analyzing the results of the different techniques. Adverse events were rarely reported and did not correlate with any processing method in particular.
Conclusions: No firm concluding recommendation can be made to deem 1 processing technique superior to the others. However, it would seem that techniques, which use a combination of gentle washing and centrifugation, strike the optimal balance of preserving adipocyte viability while removing bulk of the contaminants.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00020http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/In_Support_of_Using_Computer_Aided_Design_and.21.aspx
Abstract: Three-dimensional virtual surgical planning using computer-aided design and modeling (CAD/CAM) has gained popularity in planning complex orthognathic and osteocutaneous free flap reconstructions of the head and neck because of its ability to guide complex geometric planning in three-dimensional space and save time in the operating room. The purpose of this study was to review our experience using CAD/CAM concepts in periorbital osteotomies. Three complex periorbital osteotomies were planned and performed: 1 case of bilateral vertical and horizontal orbital dystopia, 1 case of a Monobloc-Le Fort II in an Apert patient, and 1 case of recurrent hypertelorism in a patient with craniofrontal nasal dysplasia. The patients’ charts were reviewed, including photographs, medical records, and CAD/CAM plans. The CAD/CAM planning sessions were held 3 to 6 weeks preoperatively and lasted approximately 1 hour. Both cutting guides and positioning guides were used, translating to significant precision of both the osteotomy as well as the final position of the orbits. Qualitatively, the cutting and positioning guides were easy to use and improved operating room efficiency. To conclude, in our hands, CAD/CAM virtual surgical planning is safe and effective in the performance of complex periorbital osteotomies. More work is needed to more clearly define surgical indications for this costly, new technology.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00021http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Evaluating_the_Safety_and_Efficacy_of_Tranexamic.22.aspx
Background: Blood loss is the leading cause of mortality after major craniofacial surgery. Autologous blood donation, short-term normovolemic hemodilution, and intraoperative blood salvage have shown low efficacy in decreasing transfusions. Tranexamic acid (TXA) is a synthetic antifibrinolytic drug that competitively decreases the conversion of plasminogen to plasmin, thereby suppressing fibrinolysis. The purpose of this study was to investigate the impact that TXA administration has on intraoperative blood loss and blood product transfusion in pediatric patients undergoing cranial vault reconstruction.
Methods: An Internal Review Board-approved retrospective study was conducted on a consecutive series of pediatric patients undergoing cranial vault reconstruction from January 2009 to June 2012. Seventeen consecutive patients who received TXA at the time of cranial vault reconstruction were compared with 20 patients who did not receive TXA. Criteria for blood product transfusion were identical for both groups. Outcomes including perioperative blood loss, volume of blood transfused, and adverse effects were analyzed.
Results: The TXA group had a significantly lower perioperative blood loss (9.4 versus 21.1 mL/kg, P < 0.0001) and lower volume of perioperative mean blood product transfusion (12.8 versus 31.3 mL/kg, P < 0.0001) compared with the non-TXA group. There was no significant difference in demographic data, infection rate, change in preoperative to postoperative hematocrit, duration of surgery, or complication rates between the TXA and non-TXA groups. No drug-related adverse effects were identified in patients who received TXA.
Conclusions: The use of TXA in pediatric cranial vault reconstruction significantly reduces perioperative blood loss and blood product transfusion requirements. The TXA administration is safe and may improve patient outcomes by decreasing the likelihood of adverse effects related to blood product transfusion.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00022http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Changing_Trends_in_Adult_Facial_Trauma.23.aspx
Objective: The aim of this study was to determine whether the incidence of facial fractures has changed in the United States since 1990.
Study Design: This study is a retrospective review of all nonpediatric inpatient and outpatient facilities of the Detroit Medical Center from 1990 to 2011 and weighted national inpatient estimates from 1993 to 2010 using the National Inpatient Survey.
Methods: Facial fractures and surgical repairs were grouped according to fracture site and scaled to annual populations. Chow testing determined the year with the most significant change in trend, and regressions were performed before and after the break point.
Results: Chow testing showed the year 2000 as the most significant break point across all data sets. National inpatient and institutional data showed a significant decrease in total fractures and most subsites during the 1990s and an increase since 2000. Since 1990, the rate of fracture repairs decreased at our institution and during inpatient stays in the United States. Motor vehicle–related injuries have decreased since the early 1990s. Assault rates have fallen nationally but increased slightly in Detroit.
Conclusions: Evidence from the largest institutional series of adult facial fractures and the largest national inpatient database supports a decrease in fractures and repairs during the 1990s and an increase in fractures despite no change in repairs since 2000. These trends are likely related to increasing use of computed tomographic imaging, decreasing severity of facial injuries, and changing incidences of the major etiologies of facial fractures.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00023http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/A_Comparison_and_Cost_Analysis_of_Cranioplasty.24.aspx
Background: Cranioplasty can be performed either with gold-standard, autologous bone grafts and osteotomies or alloplastic materials in skeletally mature patients. Recently, custom computer-generated implants (CCGIs) have gained popularity with surgeons because of potential advantages, which include preoperatively planned contour, obviated donor-site morbidity, and operative time savings. A remaining concern is the cost of CCGI production. The purpose of the present study was to objectively compare the operative time and relative cost of cranioplasties performed with autologous versus CCGI techniques at our center.
Methods: A review of all autologous and CCGI cranioplasties performed at our institution over the last 7 years was performed. The following operative variables and associated costs were tabulated: length of operating room, length of ward/intensive care unit (ICU) stay, hardware/implants utilized, and need for transfusion.
Results: Total average cost did not differ statistically between the autologous group (n = 15; $25,797.43) and the CCGI cohort (n = 12; $28,560.58). Operative time (P = 0.004), need for ICU admission (P < 0.001), and number of complications (P = 0.008) were all statistically significantly less in the CCGI group. The length of hospital stayand number of cases needing transfusion were fewer in the CCGI group but did not reach statistical significance.
Conclusion: The results of the present study demonstrated no significant increase in overall treatment cost associated with the use of the CCGI cranioplasty technique. In addition, the latter was associated with a statistically significant decrease in operative time and need for ICU admission when compared with those patients who underwent autologous bone cranioplasty.
Level of evidence: IV, therapeutic]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00024http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Perioperative_Complications_Associated_With.25.aspx
Abstract: Within the diagnosis “craniosynostosis,” there is a subset of patients who present with isolated, nonsyndromic, single-suture involvement. This study evaluates perioperative complications in this specific subset of patients over 4 decades at a single institution. To do so, we performed a retrospective review on consecutive patients undergoing correction of single-suture synostosis from May 1977 to January 2013 at a tertiary pediatric craniofacial center. Demographic information, operative details, and perioperative course were collected. Complications were categorized as either major or minor. A χ2 test and Fisher exact test were used to compare all categorical variables. Continuous variables were analyzed using Wilcoxon rank-sum and Kruskal-Wallis tests.
Seven hundred forty-six patients underwent surgical correction of nonsyndromic craniosynostosis. Of these, there were 307 (41.2%) sagittal, 201 (26.9%) metopic, and 238 (31.9%) unicoronal. Thirty-four patients had complications (4.6%). Eight were considered major (1.1%), including one postoperative mortality in a patient with hypoplastic left-sided heart syndrome. Minor complications occurred in 26 patients (3.5%) and included subgaleal hematoma (n = 3), seroma (n = 4), and superficial wound infection (n = 5). Metopic and sagittal suture involvement was significantly associated with a higher complication rate (P = 0.04). A child with isolated single suture synostosis and any comorbidity had a significantly greater risk of any complication (P < 0.001; odds ratio, 3.8) and specifically an increased risk of major complication (P = 0.031; odds ratio, 6.0). Subclassification of patients by time period yielded no statistically significant changes in perioperative morbidity. To conclude, these data allow us to counsel families more accurately with regard to morbidity and mortality and may potentially serve as a benchmark for future quality improvement work.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00025http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Complications_in_54_Frontofacial_Distraction.26.aspx
Abstract: Patients with syndromic craniosynostosis manifest midfacial hypoplasia often treated by midfacial advancement. Benefits of midfacial advancement by distraction osteogenesis have been well studied; little is known about the perioperative morbidity of these procedures, specifically relating to device selection. This study compares the perioperative complications between semiburied- and halo-type distraction osteogenesis of the midface. A retrospective review was performed on all patients with syndromic craniosynostosis who underwent midface distraction with semiburied- or halo-type external distractors. Demographic information and operative/postoperative course were reviewed. Complications were categorized as hardware-related, infectious, and either as major (requiring additional intervention) or minor (requiring medication only). Chi-squared and Fisher exact test were used to compare variables.
From 1999 to 2012, a total of 54 patients underwent midface distraction osteogenesis, including 23 patients with Apert syndrome, 19 patients with Crouzon syndrome, 10 patients with Pfeiffer syndrome, and 2 patients with other craniofacial syndromes. Thirty-three patients underwent a total of 34 subcranial Le Fort III distraction procedures and 21 underwent 21 monobloc distraction procedures. The mean age during surgery was 8.0 (range, 4.0–17.7) years, whereas the mean time between distractor placement and removal was 102.9 days. Thirty procedures were performed with external halo-type distractors (18 Le Fort III and 12 monobloc distractions), whereas 25 were performed with buried midface distractors (16 Le Fort III and 9 monobloc distractions). There were no significant differences in diagnoses or interventions between the distraction devices. Of the 19 distractor-related complications, there were a total of 10 (18.2%) in the halo group including 5 (9.1%) requiring separate operative intervention as well as 9 (16.4%) in the buried distractor group including 6 (10.1%) requiring separate operative intervention. Major infections were more common in the buried distractor group (n = 8) compared with the halo distractor group (n = 3) (P = 0.048). There were 4 (7.3%) patients in the halo group who had malposition or transcranial pin migration related to postoperative positioning or falls and required operative repositioning. Frontofacial distraction is an important technique in patients with syndromic craniosynostosis. Higher rates of halo displacement requiring surgery are offset with lower rates of infections compared with buried distractors.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00026http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Are_Endoscopic_and_Open_Treatments_of_Metopic.27.aspx
Background: Patients with metopic craniosynostosis are traditionally treated with fronto-orbital advancement to correct hypotelorism and trigonocephaly. Alternatively, endoscopic-assisted treatment comprises narrow ostectomy of the fused suture followed by postoperative helmet therapy. Here we compare the preoperative and 1-year postoperative results in open versus endoscopic repairs.
Methods: We reviewed preoperative and 1-year postoperative three-dimensional reconstructed computed tomography scans of patients treated for nonsyndromic metopic craniosynostosis by either open (n = 15) or endoscopic (n = 13) technique. Hypotelorism was assessed by interzygomaticofrontal distance and intercanthal distance. Trigonocephaly was assessed by 2 independent angles: first, an axial-plane two-dimensional angle between zygomaticofrontal suture bilaterally and the glabella (ZFR-G-ZFL); second, an interfrontal angle (IFA) between the most anterior point from a reconstructed midsagittal plane and supraorbital notch bilaterally. Age-matched scans of unaffected patients (n = 28) served as controls for each postoperative scan.
Results: Patients with open repair (9.5 ± 1.8 months) were older at time of surgery than patients with endoscopic repairs (3.3 ± 0.4 months) (P = 0.004). Male-to-female ratios were equivalent at roughly 7:3 in both groups. Preoperatively, the endoscopic group had worse hypotelorism and ZFR-G-ZFL than the open group (P ≤ 0.04). After accounting for preoperative differences, all of the postoperative measurements (ie, interzygomaticofrontal distance, intercanthal distance, ZFR-G-ZFL angle, IFA) of the 2 groups were statistically equivalent (P ≥ 0.135). Trigonocephaly was significantly improved after repair in both the open (8 degrees [ZFR-G-ZFL] and 18 degrees [IFA]) and endoscopic (13 degrees [ZFR-G-ZFL] and 16 degrees [IFA]) groups (P < 0.001). Postoperative measures in both groups were equivalent to controls (0.12 < P < 0.89). Intrarater reliability ranged from 0.93 to 0.99 for all measurements.
Conclusion: Our retrospective series shows that endoscopic and open repairs of metopic craniosynostosis are equivalent in improving hypotelorism and trigonocephaly at 1-year follow-up. Additional studies are necessary to better define minor differences in morphology, which may result from the different techniques.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00027http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Analysis_of_Morbidity_and_Mortality_in_Patients.28.aspx
Abstract: The relative rarity of skull base tumors has limited surgeons’ ability to report on morbidity and mortality in a large and nationwide patient series. We aimed to assess the impact of reconstructive procedures on patients undergoing skull base surgery and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent reconstruction and those who did not. We performed a retrospective analysis using American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 databases. Chi-squared tests were used for categorical variables and t-tests were used for continuous variables. Multiple logistic regression analysis predicted the influence of preoperative and operative variables on complications. A total of 479 patients were included in our study; 199 patients received concurrent reconstruction. There was no statistically significant difference in wound complication, morbidity, length of total hospital stay, and mortality between the 2 groups. The reconstruction cohort showed significantly longer operative times (416.45 [207.585] versus 319.99 [222.813] min, P = 0.001) and higher return to the operating room rate (13.6% versus 6.1%, P = 0.005). Reconstruction using pedicled flaps was associated with increased odds of wound complications (odds ratio, 4.937; P = 0.023), and microsurgical reconstruction was associated with return to the operating room (odds ratio, 2.212; P = 0.015). According to logistic regression, dyspnea, diabetes mellitus, functional status, and tumor involving the central nervous system were associated with complications. This study is the first comprehensive analysis of reconstruction after skull base surgery. Additional measures involved in flap reconstruction are associated with an increase in operation time and return to the operating room rate but not with complications, morbidity, or mortality.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00028http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Facial_Changes_After_Early_Treatment_of_Unilateral.29.aspx
Background: The premature fusion of unilateral coronal suture can cause a significant asymmetry of the craniofacial skeleton, with an oblique deviation of the cranial base that negatively impacts soft tissue facial symmetry. The purpose of this study was to assess facial symmetry obtained in patients with unilateral coronal synostosis (UCS) surgically treated by 2 different techniques. We hypothesized that nasal deviation should not be addressed in a primary surgical correction of UCS.
Methods: Consecutive UCS patients were enrolled in a prospective study and randomly divided into 2 groups. In group 1, the patients underwent total frontal reconstruction and transferring of onlay bone grafts to the recessive superior orbital rim (n = 7), and in group 2, the patients underwent total frontal reconstruction and unilateral fronto-orbital advancement (n = 5). Computerized photogrammetric analysis measured vertical and horizontal axis of the nose and the orbital globe in the preoperative and postoperative periods. Intragroup and intergroup comparisons were performed.
Results: Intragroup preoperative and postoperative comparisons showed a significant (all P < 0.05) reduction of the nasal axis and the orbital-globe axis in the postoperative period in the 2 groups. Intergroup comparisons showed no significant difference (all P > 0.05).
Conclusions: Facial symmetry was achieved in the patients with UCS who underwent surgery regardless of surgical approach evaluated here. Our data showed a significant improvement in nasal and orbital-globe deviation, leading us to question the necessity of primary nasal correction in these patients.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00029http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Deformational_Plagiocephaly_and_Craniosynostosis__.30.aspx
Background: In 1992, the American Academy of Pediatrics discouraged prone sleeping positions because of its association with sudden infant death syndrome.1 After this was an increased incidence of deformational plagiocephaly (DP).
Methods: A retrospective review was completed for patients with DP and craniosynostosis seen by plastic surgeons at a tertiary medical center during a 19-year period. Two groups of patients were evaluated before (1988–1995) and after (1996–2007) implementation of the “Back to Sleep” campaign.
Results: Of the 5169 patients, those with craniosynostosis (n = 279) had a mean age at initial evaluation before and after 1996 of 12.4 versus 5.6 months (P = 0.0008). There was a trend of decreasing age at initial evaluation and first surgery after 1996. For patients with DP (n = 4890), the mean age at initial evaluation before and after 1996 was 11.5 versus 6.0 months (P = 0.10). There was a trend of decreasing age at initial evaluation and DP correction after 1996. The majority of patients had right-sided DP (50.2%), followed by left-sided (24.7%) and bilateral (18.9%). There was no significant difference in DP correction rate (67% versus 87%) or the mean age that DP was corrected (12.8 versus 11.8 mo) before and after 1996. Compared with 1996 to 1999, there was a 214% and 390% increase in DP referrals from 2000 to 2003 and 2004 to 2007. For craniosynostosis, there was a 27% and 129% increase in referrals.
Conclusions: The increasing incidence of DP since the Back to Sleep campaign is concerning, but a positive outcome is that patients are being referred and treated at a younger age.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00030http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Impact_of_Torticollis_Associated_With.31.aspx
Objective: This study investigated whether torticollis (congenital or acquired) in infants with plagiocephaly affects the achievement of specific gross motor milestones.
Methods: A total of 175 infants affected by plagiocephaly with or without torticollis were recruited and included in this prospective trial. Anthropometric and clinical variables were recorded at baseline. The infants were included in a physiotherapy treatment program, and they were monthly assessed until hospital discharge.
Results: Significant differences (P < 0.05) were observed in the achievement of rolling over, crawling, and standing skills depending on the specific profile (plagiocephaly and plagiocephaly with congenital or acquired torticollis). After adjusting for the severity of the plagiocephaly and the age at referral, the torticollis was significantly (P < 0.05) associated with crawling and standing skills.
Conclusions: The findings suggest that the presence or absence of congenital or acquired torticollis is an important factor that affects gross motor development in infants with plagiocephaly.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00031http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/In_Vitro_Comparison_of_the_Effect_of_Different.32.aspx
Background and Aims: Use of dental implants in edentulous patients has become a common treatment modality. Treatment of such implants requires radiographic evaluation, and in most cases, several different imaging techniques are necessary to evaluate the height, width, and structure of the bone at the implant site. In the current study, an attempt was made to evaluate the accuracy of measurements on cone beam computed tomography (CBCT) images with different slice thicknesses so that accurate data can be collected for proper clinical applications.
Materials and Methods: In the present in vitro study, 11 human dry mandibles were used. The width and height of bone at the central, canine, and molar teeth areas were measured on the left and right sides by using digital calipers (as gold standard) and on CBCT images with 0.5-, 1-, 2-, 3-, 5-, and 10-mm slice thicknesses. Data were analyzed with SPSS 16, using paired t-test, Tukey test, and inter class correlation.
Results: Data were collected by evaluation of 11 skulls and 63 samples on the whole. There were no significant differences in bone width in any area (P > 0.05). There were significant differences in bone height in the central and molar teeth areas (P = 0.02). The measurements were not significant only at 4-mm slice thickness option and 5-mm slice thickness option for height compared with the gold standard (P = 0.513 and 0.173, respectively). The results did not show any significant differences between the observers (P = 0.329).
Conclusion: The highest measurement accuracy of CBCT software program was observed at 4-mm slices for bone width and 5-mm slice thickness for bone height.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00032http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Effects_of_Open_and_Endoscopic_Surgery_on_Skull.33.aspx
Background: There have been conflicting reports on how sagittal synostosis affects cranial vault volume (CVV) and which surgical approach best normalizes skull volume. In this study, we compared CVV and cranial index (CI) of children with sagittal synostosis (before and after surgery) with those of control subjects. We also compared the effect of repair type on surgical outcome.
Methods: Computed tomography scans of 32 children with sagittal synostosis and 61 age- and sex-matched control subjects were evaluated using previously validated segmentation software for CVV and CI. Sixteen cases underwent open surgery, and 16 underwent endoscopic surgery. Twenty-seven cases had both preoperative and postoperative scans.
Results: Age of subjects at computed tomography scan ranged from 1 to 9 months preoperatively and 15 to 25 months postoperatively. Mean age difference between cases and matched control subjects was 5 days. The mean CVV of cases preoperatively was nonsignificantly (17 mL) smaller than that of control subjects (P = 0.51). The mean CVV of postoperative children was nonsignificantly (24 mL) larger than that of control subjects (P = 0.51). Adjusting for age and sex, there was no significant difference in CVV between open and endoscopic cases postoperatively (β = 48 mL, P = 0.31). The mean CI increased 12% in both groups. There was no significant difference in mean postoperative CI (P = 0.18) between the 2 groups.
Conclusions: Preoperatively, children with sagittal synostosis have no significant difference in CVV compared with control subjects. Type of surgery does not seem to affect CI and CVV 1 year postoperatively. Both open and endoscopic procedures result in CVVs similar to control subjects.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00033http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Horner_Syndrome_in_Neurofibromatosis_Type_1.34.aspx
Abstract: The authors report a rare case of Horner syndrome in a patient with neurofibromatosis type 1 (NF-1). A 31-year-old man visited the clinic with drooping left eyelid. The physical examination revealed ptosis of the left eyelid, miotic pupil, facial anhidrosis, and several skin masses on the chest. The radiological examination of the chest demonstrated a well-defined left posterior mediastinal mass close to the vertebral bodies of the upper thoracic spine at the level of T1-T5. The masses of mediastinum and skin were totally removed. They were diagnosed as neurofibromas. Neurofibromatosis type 1 was diagnosed. To the best of my knowledge, this is a rare case of a patient with NF-1 who presented with Horner syndrome. Clinicians should be vigilant on the possibility of Horner syndrome in patients with NF-1.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00034http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Awful_Face_of_the_War_Impacted_Smoke_Bomb_Capsule.35.aspx
Abstract: In this study, a rare kind of injury due to smoke bomb capsule impaction to midface and under the cranial base is presented, and maneuvers to reduce mortality are discussed.
Three male patients were presented with impacted smoke bomb capsules into the midface and under the cranial base structures. Midface structures, anterior cranial base, and, in 2 patients, unilateral eye were severely damaged.
Two patients died after the initial emergency operations because their lung disease progressed to acute respiratory distress syndrome. One of the patients lived, and soft tissue reconstruction was achieved by using temporal transposition and cheek advancement skin flaps with split-thickness skin graft from donor site.
However, craniofacial destruction is important in these patients; a multidisciplinary approach is needed for the treatment of direct smoke bomb injuries because the patients experienced chemical burn and acute trauma. The timing of maxillofacial reconstruction is also a question in these specific patients.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00035http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Intracranial_Repair_of_Posttraumatic_Cerebrospinal.36.aspx
Objective: The purposes of this study are to assess the efficacy of our intracranial surgery and evaluate the association between failure after first surgical repair and the risk factors that have been applied on a group of 13 patients affected by posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis.
Methods: We retrospectively collected data on 13 patients referred to our institution. All patients had history of head trauma and experienced 2 or more episodes of meningitis.
Results: Three of the 13 patients had craniectomy defect due to previous trauma and surgery, 9 patients had linear fracture, and 1 patient had no apparent fracture line on preoperative radiologic evaluation. Ten of the 13 patients had identified frontal bone fracture involving the frontal sinus during surgery. Dural tear was identified intradurally and was repaired using a fascia lata graft with or without fibrin glue. Fibrin glue was applied over the suture in 7 patients. Three of the 13 patients had large dural defects.
Conclusions: The size of bone and dural defect seems to be an important prognostic factor of episodes of meningitis. The use of fibrin glue to fixate fascia lata graft did not benefit the outcome.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00036http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Frontosphenoid_Synostosis___An_Unusual_Cause_of.37.aspx
Abstract: Nonpositional anterior plagiocephaly results commonly from unilateral coronal craniosynostosis. We present 2 patients of a rare cause of anterior plagiocephaly known as frontosphenoid synostosis. This condition is characterized by the absence of a harlequin eye (or the harlequin sign on computed tomography), which is usually present in unilateral coronal synostosis. We also observed no reduction in the ear-eye distance, which can distinguish it from coronal craniosynostosis.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00037http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/New_Onset_Craniosynostosis_After_Posterior_Vault.38.aspx
Abstract: The aims of this study were to document the incidence of new-onset craniosynostosis (NOC) after posterior vault distraction osteogenesis (PVDO), to determine risk factors for the development of NOC, and to deduce the cranial ramifications of NOC. An institutional review board–approved retrospective review of all patients who underwent PVDO at the Children’s Hospital of Philadelphia was performed. Demographics, perioperative data, as well as preoperative and postoperative three-dimensional computed tomographic scans were analyzed. Suture patency preoperatively and postoperatively was recorded.
Thirty patients underwent PVDO for suspected increased intracranial pressure and/or severe turribrachicephaly from 2008 to 2013. Twenty-four patients had syndromic diagnoses. The average age at the time of PVDO was 2.03 years. Distraction distances ranged from 19 to 40 mm, with an average of 28.7 mm. Among the 19 patients who had patent lambdoid sutures before PVDO, new-onset lambdoid fusion was seen in 17 patients after PVDO (89.5%), whereas the suture remained open in 2 patients (10.5%). New-onset lambdoid fusion was not significantly associated with age at distraction (P = 0.28), sex (P = 0.47), length of distraction (P = 0.93), or diagnosis (P = 0.61). Similarly, new-onset sagittal synostosis was not associated with age at distraction (P = 0.06), sex (P = 0.64), length of distraction (P = 0.83), or diagnosis (P = 0.25). None of the patients who developed NOC had characteristic head shape changes such as mastoid bulges or scaphocephaly. New-onset lambdoid and sagittal synostoses occur frequently after PVDO. Although the diagnosis of NOC is obvious radiographically, the clinical importance of the diagnosis morphometrically, neurodevelopmentally, and in cranial growth has yet to be fully investigated.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00038http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Asymmetrically_Pressing_Nasal_Splint_for_Crooked.39.aspx
Objectives: Correcting crooked nose deformity is one of the most difficult procedure in rhinoplastic surgery. For that reason, the authors have been designed an asymmetrically pressing nasal splint. In this prospective study, the aim was to compare the effects of applying asymmetrically pressing nasal splint and normal symmetrically splint on the crooked nose.
Methods: This study included 129 patients who were operated on for crooked nose deformity. Patients were divided into 2 groups. Normal symmetrically pressing nasal splint was applied to groups 1a (I type) and 1b (C type). Asymmetrically pressing nasal splint was applied to groups 2a (I type) and 2b (C type). All groups were compared according to deflection angle from the midline, the percentage of postoperative improvement, patient satisfaction with visual analog scale, and complication rate.
Results: I-type noses in both groups at postoperative angle values were reduced, and C-type noses in both groups at postoperative angle values were increased significantly compared with preoperative values. I-type noses of group 2 at postoperative angle values compared with group 1 were reduced, and C-type noses were increased in group 2 significantly. Patient satisfaction rate in group 2 were significantly better than in group 1. The closeness ratios to the ideal angles in group 1 were in “good” and “moderate” levels, whereas in group 2, it was in “excellent” level. There was no significant difference in complication rate in both groups.
Conclusions: Asymmetrically pressing splint (novel design) showed increasing success rate clearly in crooked nose surgery than in normal splints.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00039http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Prevalence_of_Chronic_Rhinosinusitis_in_the.40.aspx
Abstract: Behçet disease (BD) is a systemic autoimmune/autoinflammatory, T helper 1–mediated condition. It is well known that the prevalence of a T helper 1–mediated disease increases in the presence of another T helper 1–mediated comorbidity. The purpose of this study was to investigate the prevalence of T helper 1–mediated chronic rhinosinusitis without nasal polyposis (CRSsNP) and T helper 2–mediated chronic rhinosinusitis with polyposis in the presence of comorbid BD. Sixty-nine patients and 74 healthy controls were included in the study. Participants were asked to complete a questionnaire for symptoms of rhinosinusitis. Nasal cavities were scored using the Lund-Kennedy endoscopy scores. Paranasal sinus computed tomography imagings were scored according to Lund-Mackay radiology scores. Skin prick tests were carried out for all participants to determine the predisposing role of allergy (T helper 2 disease) in the etiopathogenesis of rhinosinusitis among patients and controls. Patients’ endoscopy, radiology, and skin prick testing scores were evaluated with regard to BD activity.
The prevalence of CRSsNP was 23.2 % in BD and 2.7% in normal population. The CRSsNP was more frequently seen in patients than in the healthy controls (P = 0.002). The BD patients displayed worse scores on their left sinonasal endoscopy. No statistically significant difference was seen between BD and control groups with regard to Lund-Mackay radiology scores of both sides. The presence of an allergic response to a specific allergen in skin-prick testing were confirmed in 25 patients (36.2%) and 17 controls (23.0%). However, the difference was not statistically significant. There were positive responses to more allergens when BD activity was reduced.
The CRSsNP thought to be of T helper 1–mediated origin was more frequently seen in the presence of comorbid BD.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00040http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Idiopathic_Sixth_Nerve_Palsy_After_Bimaxillary.41.aspx
Abstract: This was a case of a 21-year-old female patient with a very rare and unexpected symptom “diplopia occurring due to the idiopathic sixth nerve palsy” encountered after 2 weeks following bimaxillary surgery performed for the correction of class III malocclusion deformity.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00041http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Subdural_Hygroma_After_Craniosynostosis_Remodeling.42.aspx
Abstract: Craniosynostosis is defined as the premature fusion of the cranial sutures and can cause functional impairment or cosmetic deformity. Surgical techniques for the correction of craniosynostosis have changed overtime, as so have the intraoperative and postoperative complications. Extensive surgeries involving fronto-orbital unit repositioning and cranial vault remodeling are associated with various complications. Intraoperative and postoperative hemorrhage, venous infarct, air embolism, hydrocephalus, cerebrospinal fluid leak, as well as meningitis are a few complications associated with cranial vault remodeling surgery. Postoperative complications can increase the morbidity and mortality associated with these procedures. Identification of the complications and their timely management should be a part of every craniofacial reconstruction team’s training program.
In this article, we report a case of subdural hygroma in an infant after cranial vault remodeling procedure. Subdural hygroma is a known complication following head injuries and represents 5% to 20% of posttraumatic intracranial mass lesions. However, subdural hygroma developing after a cranial procedure is rare and has not been reported in the literature. Identification of the complication, close monitoring of the change in subdural fluid volume, and tapping of the fluid through the craniotomy site if indicated form the mainstay of management of subdural hygroma that develops after cranial vault remodeling surgery.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00042http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Hypertelorism_Correction_With_Facial_Bipartition.43.aspx
Objective: Hypertelorism may be corrected by either transcranial box osteotomy or facial bipartition. Despite radical bony resection, the associated soft tissue translation often seems disproportionate. The purpose of this study was to review bony and soft tissue movements in a series of 15 consecutive hypertelorism correction cases.
Methods: Two surgical residents in training independently analyzed preoperative and postoperative axial and three-dimensional reconstructed computed tomography data from 15 consecutive patients undergoing facial bipartition (n = 7) or transcranial box osteotomy correction (n = 8) between 2001 and 2010. Anterior interorbital distance, lateral interorbital distance, midpoint globe distance, and globe protrusion were measured along with intercanthal distance and palpebral fissure width.
Results: The mean preoperative anterior interorbital distance was 35.5 mm; postoperatively, there was a mean reduction of 9.5 mm, to 26 mm. The mean preoperative intercanthal distance was 48.1 mm; there was a mean reduction of 10.3 mm, to 37.8 mm. The mean preoperative midpoint globe distance was 69.5 mm; there was a mean reduction of 9.6 mm, to 59.9 mm. The mean preoperative globe protrusion was 17.6 mm; there was a mean reduction of 5 mm, to 12.6 mm (28.5%). The mean interclass correlation (a measurement of interrater congruency with 1 being complete agreement) was 0.85
Conclusions: Transcranial box osteotomy and facial bipartition correct hypertelorism. The medial canthal tendons, lateral canthal tendons, and globes move in proportion to the bony attachments. We observed a reduction in globe protrusion an average of 29%, therefore risking enophthalmos.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00043http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endoscopic_Endonasal_Transsphenoidal_Surgery_for.44.aspx
Objective: The objective of this study was to report the efficacy, safety, and outcomes of endoscopic endonasal transsphenoidal techniques for pituitary adenomas.
Patients and Methods: A retrospective data analysis of 32 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma between February 2011 and December 2013 was performed. The patients’ demographic data, clinical presentations, radiologic findings, recurrence rates, and complications were analyzed.
Results: There were 14 men and 18 women with age ranging from 23 to 74 years (mean age, 48.6 y). Functioning and nonfunctioning tumors were present in 22 (68.8%) and 10 patients (31.2%), respectively. Among the functioning adenomas, 8 patients (25%) had growth hormone–secreting adenomas, 6 patients (18.8%) had prolactinomas, 5 patients (15.6%) had adrenocorticotropic hormone–secreting adenomas, 2 patients (6.2%) had follicle-stimulating hormone/luteinizing hormone–secreting adenomas, and 1 patient (3.1%) had thyroid-stimulating hormone–secreting adenomas. Of the 32 patients, 20 (62.5%) had pituitary macroadenomas and 12 patients (37.5%) had microadenomas. Total-subtotal tumor resection was achieved in 75% and 45% of the microadenomas and macroadenomas, respectively. Radiologically, 60% of the macroadenomas had suprasellar and carvenous sinus extension. Postoperative cerebrospinal fluid leaks occurred in 3 patients. Two patients developed temporary diabetes insipidus.
Conclusions: Endoscopic transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in these patients.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00044http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Remifentanil,_Ketamine,_and_Propofol_in_Awake.45.aspx
Background: Nasotracheal intubation of patients with temporomandibular joint (TMJ) ankylosis is a challenge for anesthesiologists. Awake fiberoptic intubation (AFOI) is the safest technique in patients with difficult airway. This study compares 3 different techniques of conscious sedation during AFOI in patients with TMJ ankylosis.
Methods: This study comprised 54 patients, American Society of Anesthesiologists physical status 1, scheduled for TMJ surgery. The patients were randomly allocated to remifentanil group (n = 18, 0.75 μg/kg over 30 seconds), ketamine group (n = 18, 0.25 mg/kg over 30 seconds), or propofol group (n = 18, 0.5 mg/kg over 30 seconds) for conscious sedation. The main determinants affecting the patient’s outcome included intubation time, intubation conditions, and patient discomfort, which were determined by scoring system. In addition, postoperative patient dissatisfaction, hemodynamic stability, and respiratory impairment were measured.
Results: Intubation times were significantly different between groups (P < 0.001), where remifentanil had the shortest time (30.28 seconds). Intubation conditions (scores 0–3) were significantly different between groups (P < 0.001).In this context, remifentanil had score 3 (2–3), which was higher compared with 2 (1–3) for ketamine and 2 (1–2) for propofol. Patient discomfort score was lowest in the remifentanil group. Hemodynamic stability was maintained within groups, and its changes were not significant (P > 0.05). Postoperative patient’s dissatisfaction was observed in 2, 3, and 5 patients in remifentanil, ketamine, and propofol groups, respectively. Respiratory impairment (apnea) recorded lowest in the remifentanil group.
Conclusions: Remifentanil was the best agent for AFOI, because it provided shorter intubation time, better intubation conditions, and least patient’s complaint.
Iranian registry no.: IRCT 201208061674N4 (www.irct.ir ).]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00045http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Systematic_Reviews_Addressing_Microsurgical_Head.46.aspx
Background: Systematic reviews frequently form the basis for clinical decision making and guideline development. Yet, the quality of systematic reviews has been variable, thus raising concerns about the validity of their conclusions. In the current study, a quality analysis of systematic reviews was performed, addressing microsurgical head and neck reconstruction.
Materials and Methods: A PubMed search was performed to identify all systematic reviews published up to and including December 2012 in 12 surgical journals. Two authors independently reviewed the literature and extracted data from the included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR.
Results: The initial search retrieved 1020 articles. After screening titles and abstracts, 987 articles were excluded. Full-text review of the remaining 33 articles resulted in further exclusion of 18 articles, leaving 15 systematic reviews for final analysis. A marked increase in the number of published systematic reviews over time was noted (P = 0.07). The median AMSTAR score was 5, thus reflecting a “fair” quality. No evidence for improvement in methodological quality over time was noted.
Conclusions: The trend to publish more systematic reviews in microsurgical head and neck reconstruction is encouraging. However, efforts are indicated to improve the methodological quality of systematic reviews. Familiarity with criteria of methodological quality is critical to ensure future improvements in the quality of systematic reviews conducted in microsurgery.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00046http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Simultaneous_Unicoronal_and_Sagittal_Distraction.47.aspx
Abstract: We present a case of multiplanar distraction osteogenesis for the simultaneous treatment of sagittal and unicoronal craniosynostosis in a nonsyndromic 2-month-old boy. Unilateral fronto-orbital advancement and sagittal suturectomy were performed. Distracters were fixed orthogonally in the sagittal and coronal positions to distract the affected coronal and sagittal sutures. The devices achieved 20 and 22 mm of advancement in the coronal and sagittal locations. A total intracranial volume increase of 62% was noted at 6 months’ follow-up. This preliminary report demonstrates the procedure’s short-term safety; future investigation is needed over the long term to determine its efficacy.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00047http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Malignant_Hyperthermia_in_a_3_Year_Old_Child_With.48.aspx
Abstract: Freeman-Sheldon syndrome is a congenital disorder that has been suggested to be associated with malignant hyperthermia. Clinical features of the Freeman-Sheldon syndrome include flexion contractures and characteristic facial features, including microstomia and a whistling shape to the lips. We report a case of malignant hyperthermia in a 3-year-old girl with microstomia but no other features of Freeman-Sheldon syndrome. The purpose of this report was to review the diagnosis and treatment of malignant hyperthermia as craniofacial surgeons have an increased exposure to this rare and potentially fatal condition.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00048http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Effect_of_Restraining_Devices_on_Eye_Injury_in.49.aspx
Abstract: The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury in motor vehicle collisions (MVCs).
In a PubMed search, the search terms “eye injury and seatbelt,” “eye injury and car belt,” “eye injury and airbag,” and “eye injury and restraining” were used. Among the 30 potentially relevant articles, 5 articles met our inclusion criteria. The odds ratio (OR) and 95% confidence intervals (CIs) from each study were abstracted. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).
Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77–1.56). Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50–0.51).
Seat belts were effective to decrease eye injuries in MVCs. However, airbags had no significant effect on an increase to eye injuries. When using airbags, seat belts should be used together.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00049http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Achondroplasia_and_Multiple_Suture.50.aspx
Abstract: Genetic mutations in the fibroblast growth factor receptor 3 gene may lead to achondroplasia or syndromic forms of craniosynostosis. Despite sharing a common genetic basis, craniosynostosis has rarely been described in cases of confirmed achondroplasia. We report an infant with achondroplasia who developed progressive multiple-suture craniosynostosis to discuss the genetic link between these clinical entities and to describe the technical challenges associated with the operative management.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00050http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Does_Perioperative_Steroid_Use_Improve_Clinical.51.aspx
Background: The benefits of routine perioperative steroid use to decrease facial edema, ecchymosis, pain, and reduced length of hospitalization have been reported for many procedures. The role of perioperative steroids after open craniosynostosis surgery remains understudied. The purpose of our study was to assess the safety and efficacy of perioperative steroid administration in open repair of craniosynostosis based on current published clinical evidence.
Methods: A systematic review of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane library databases using inclusion and exclusion criteria was performed for articles that studied the efficacy of perioperative steroid use in craniosynostosis patients receiving open cranial repair surgery.
Results: Our review yielded 149 unique citations. One hundred thirty-nine titles were excluded based on predefined criteria. Ten abstracts and 4 articles (n = 14) qualified for full-text screening. Two additional relevant articles were identified using references. Three observational studies were eligible for data abstraction. A Cohen κ coefficient score of 0.88 demonstrated high interrater agreement throughout the screening process. Clinical benefits in this specific population observed were improved control of postoperative edema, earlier time to eye opening, and reduced length of hospital stay. The timing, method, and technique of steroid administration varied between studies.
Conclusions: The reviewed literature supports a clinical benefit following administration of perioperative steroids for open repair surgery of craniosynostosis. However, the current level of evidence on safety and efficacy remains limited in rigor and volume. Further randomized trials are necessary prior to recommending routine steroid use in our study population.
Clinical question/level of evidence: therapeutic, level III.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00051http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Modified_Submandibular_Access_for_Open_Reduction.52.aspx
Purpose: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon.
Methods: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field.
Results: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00052http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Feasibility_and_Clinical_Outcomes_of_Transoral.53.aspx
Abstract: Transoral robotic surgery (TORS) has been used as a novel procedure for squamous cell carcinoma of the laryngopharyngeal cancers with encouraging outcomes. The safety, feasibility, and efficacy regarding this approach have previously been demonstrated. There are several studies proposing the benefit of combining TORS with carbon dioxide (CO2) laser in resecting upper aerodigestive tract tumors. We report a series of patients with hypopharyngeal carcinoma treated with primary TORS with or without the flexible carbon dioxide (CO2) laser. All TORS resections were completed without any intraoperative complication. None required conversion to an open procedure. Clinical outcomes in this preliminary analysis indicate that magnified view, 3D visualization with the wristed instruments and tremor reduction technology of robotic experience, allow en bloc resection of early stage hypopharyngeal cancers. TORS with CO2 laser is a promising, minimally invasive surgical alternative for the treatment of hypopharyngeal tumors with comparable oncologic outcomes.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00053http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Rotation_Technique_of_Reduction_Malar_Plasty.54.aspx
Abstract: The 2 most common complications of reduction malarplasty are nonunion or malunion and cheek drooping. Because masseter muscle is attached from zygomatic process of the maxilla to inferior two thirds of the zygomatic arch, rigid fixation and intimate bone contact without creating a gap are crucial for reduction malarplasty.
Mesial-clockwise rotation of the zygomaticomaxillary complex can produce intimate bone contact and facilitates reduction malarplasty.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00054http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endoscopic_Endonasal_Optic_Nerve_Decompression_in.55.aspx
Abstract: Pseudotumor cerebri (idiopathic intracranial hypertension) is a syndrome characterized by intracranial pressure elevation and associated signs and symptoms in the absence of a space-occupying intracranial lesion. The most common symptoms are visual loss and headache. Sometimes, surgical therapy is needed in patients who have no apparent response to medical therapy and exhibit a progressive course. Optic nerve decompression is an effective and recommended treatment approach for patients with pseudotumor cerebri in whom visual loss predominates. With the growing experience with endoscopic skull base approaches, this method has begun to be used as an alternative and effective treatment modality. In this study, we aimed to present the outcome of endoscopic endonasal optic nerve decompression and to review the literature on this treatment modality in 2 patients diagnosed with pseudotumor cerebri that was unresponsive to medical therapy and associated with progressive visual loss.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00055http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Posterior_Coronal_Incision.56.aspx
Background: The coronal incision is a standard surgical approach in craniofacial surgery. It has undergone many modifications during the years in an attempt to optimize the esthetic appearance of the scar, including the sawtooth “stealth incision” and the sinusoidal incision.
Methods: We describe an alternative coronal approach extending posteriorly from the postauricular region over the occiput, resulting in an axial scar.
Results and Discussion: The posterior coronal incision provides equivalent exposure of the craniofacial skeleton while placing the scar in an esthetically optimal location that is much more likely to be camouflaged by hair, especially in patients with thinning hair or male-pattern baldness. It avoids a vertical temporal scar that is prone to widening and also allows the incision to be placed remotely from any neurosurgical hardware in the frontotemporal region. It may be used in craniofacial or neurosurgical procedures requiring access to the posterior or anterior cranial vaults or the upper craniofacial skeleton down to the maxillary alveolar rim.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00056http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Reconstruction_for_Facial_Nerve_Defects_of.57.aspx
Background: Many reconstructive methods for facial nerve defects have been described previously, such as the greater auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. Herein, we want to instruct a new technique of repairing facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches when we have to face segment defects of facial nerve with wide gaps between facial nerve stumps.
Methods: The distal part of the upper buccal or cervical branches with peripheral tissue was removed to repair the defects of zygomatic or marginal mandibular branches. Clinical and electromyographic examinations were employed to investigate the clinical efficacy of this method.
Results: Killed branches of facial nerve included 11 marginal mandibular branches and 16 zygomatic branches in 26 patients. The length of facial nerve defects ranged from 0.9 cm to 2.3 cm with a mean gap of 1.87 cm (SD, 0.89). Seventeen patients finally showed a superb facial function (grade I), 6 patients an excellent outcome (grade II), and 3 patients a good result (grade III). A fair or poor result (grade IV or V) was not observed.
Conclusions: The essence of this method is equivalent to direct facial-facial nerve anastomosis which seems to be able to avoid synkinesis between the upper and lower face. We believe that this method is adaptable to the length of facial nerve defects less than 2 cm.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00057http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Where_to_Fix_in_Rejuvenation_Surgeries____Tensile.58.aspx
Abstract: The aim of this study is to elucidate the tensile strength of the periosteum relating to facial rejuvenation surgeries.
Twelve hemifaces of 6 formalin-fixed Korean adult cadavers were used. Two horizontal incision lines were made 3 cm above the supraorbital rim and 1 cm below the infraorbital rim. Another 2 vertical incisions were on the medial orbital rim and 2 cm lateral to the lateral orbital rim. Elevated flaps were turned over, and the undersurfaces of the periosteum were exposed. A silk string was passed below the periosteum with a 3-mm bite and wound. A 3-cm loop was made, and this was pulled away using the tensiometer. The breaking strength was measured.
The breaking strengths of the periosteum were different according to the location (P = 0.000, analysis of variation). The strongest point was 2 cm above the supraorbital rim at the medial one third of the orbit (14.05 [2.50] N) followed by 1 cm above the frontozygomatic suture (13.35 [4.70] N). The weakest point was the infraorbital rim at the lateral one third of the orbit (6.93 [3.76] N) followed by the lateral orbital rim at the level of the lateral canthus (7.60 [3.49] N). Breaking strengths of the periosteum of the medial side (11.44 [3.83] N) were significantly greater (P = 0.021, t-test) than the lateral side (9.32 [3.76] N). In the supraorbital area, the breaking strengths of the periosteum of the upper points (12.91 [3.00] N) were significantly greater (P = 0.000, t-test) than the lower points (9.36 [2.76] N).
The results of this study can be of use when choosing a fixation point in rejuvenation surgeries.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00058http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Normative_Inner_Ear_Volumetric_Measurements.59.aspx
Abstract: In the current study, we attempted to determine normative inner ear volumetric measurements generated from three-dimensional computed tomography (CT) images. In addition, we investigated a correlation between the axial length and the volume of the labyrinth and discussed clinical outcomes of this correlation. Amira 5.2.2 software was used to create three-dimensional isosurface images of the human labyrinth using two-dimensional CT images from 35 anatomically normal patients. With the three-dimensional labyrinths, complete dimensional analysis was performed to gain insight into both the volume and the greatest axial length of the inner ear. Paired t test and Pearson correlation were used. Our volume of the inner ear inquiry reported a mean volume of 221.5 with SD of 24.3 μL (0.228 μL for males and 0.218 μL for females). The length showed a mean of 1.713 cm with SD of 0.064 cm (1.753 cm for males and 1.695 cm for females). The length was used to estimate the volume, and the estimates were within 10% of the measured volume 74.3% of the time. Normative volumetric measurements of the inner ear can be obtained by using three-dimensional CT Imaging by Amira 5.2.2 software. There was a statistically significant positive correlation between the axial length of the labyrinth and the volume of the labyrinth. The axial length of the labyrinth could be used to estimate the volume of the labyrinth, which may be clinically important to estimate the concentration of the drug distributed in the inner ear.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00059http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Orbital_Volume_Measurement_in_Patients_With.60.aspx
Abstract: Enophthalmos occurs from the increased bony volume or decreased soft tissue volume in the orbit and can be caused in patients with long-term ventriculoperitoneal (VP) shunt. This study tried to find out the change of orbital volume by measuring the orbital volume before and after operation in adult patients who underwent VP shunt for hydrocephalus. The 2 evaluators measured orbital volume by using ITK-SNAP 2.4 program with double-blind test for computed tomography images before and after operation targeting 36 patients over the age of 18 who underwent VP shunt with pressure-controlled valve from 2003 to 2011. Wilcoxon matched-pairs signed-rank test of GraphPad software was used to statistically analyze the difference in orbital volume change before and after operation. In case of mean pre-op orbital volume of total 36 patients, the right was measured as 23.72 ± 4.65 cm3, the left as 23.47 ± 4.61 cm3, the post-op right as 24.67 ± 4.70 cm3, and the left as 24.18 ± 4.63 cm3, showing no statistically significant difference (P = 0.106). The mean pre-op orbital volume of 14 people (28 eyes) followed for more than 11 months was 25.06 ± 4.58 cm3 in the right and 24.4 ± 5.02 cm3 in the left and the mean post-op orbital volume was 27.0 ± 4.28 cm3 in the right and 25.76 ± 3.92 cm3 in the left, showing statistically significant differences in the change of the volume before and after shunt operation (P = 0.0057). In patients who maintain long-term shunt devices after VP shunt, remodeling of matured orbital bone may be caused due to the change in pressure gradient between cranial cavity and orbit and the possible occurrence of resulting secondary enophthalmos by increased orbital volume should be considered.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00060http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Evaluation_of_Morphometry_of_the_Mastoid.61.aspx
Abstract: The aim of this study was to examine the relationships of the bony landmarks on the lateral surface of the mastoid process (MP). It was also the target of this study to reveal the importance of sexual dimorphism in terms of the mastoid triangle. Our study was performed on 140 (70 women, 70 men) multidetector computed tomography images obtained from patients who underwent radiologic examination at the Department of Radiology of Meram Medical Faculty, Necmettin Erbakan University. The height of the MP was measured using 2 different ways. The distance between the mastoid apex and the midpoint of the distance of the porion and the mastoid notch was measured (mastoid height 1). Then, the distance between the Frankfurt horizontal plane and the mastoid apex was measured (mastoid height 2). The distances between porion–mastoid notch, porion–mastoid apex, porion-asterion, asterion–mastoid apex, articular tubercle–asterion, articular tubercle–mastoid apex, as well as the right and the left MP were also measured. Finally, the angles between porion–mastoid apex–asterion, mastoid apex–asterion– porion, and asterion–porion–mastoid apex were measured. All data were analyzed statistically using the Student’s t-test. According to the results of the measurements, all right and left parameters of the men were higher than the women’s right and left sides except for the angle between asterion–porion–mastoid apex. In addition, all right and left parameters were almost the same in both sexes. Having the knowledge of measurements of the distances between the major landmarks of the temporal bone is essential to avoid possible complications during facial, mastoid, and especially sigmoid sinus surgeries.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00061http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Sphenovomerine_Suture___A_Useful_Landmark_for.62.aspx
Aim: The aim of this study was to determine whether the sphenovomerine suture (SVS) can be used as a landmark to localize the sphenoidal sinus ostium.
Methods: Endoscopic imaging was done on 152 skulls to identify ostium of the sphenoidal sinus, the SVS, and the articulation of sphenoidal process of palatine bone between the body of the sphenoid and the sphenopalatine foramen. The variables were as follows: (1) the distance between the medial border of the ostium and SVS (DSO-SVS); (2) the angle between them (ASO-SVS); (3) the distance between the inferior border of the ostium and the horizontal line (DSO-HL); (4) the distance between intersection point of the SVS-sphenoidal process of the palatine bone and the medial border of sphenopalatine foramen (DSPF-SVS); and (5) the number of sphenopalatine foramen.
Results: Of the 152 skulls, 289 sides were included in the study. The mean value for DSO-SVS was 3.15 (1.35) mm, DSO-HL was 5.99 (2.38) mm, DSPF-SVS was 7.07 (1.96) mm, and ASO-SVS was 5.99 (9.73) mm. As DSPF-SVS decreases, DSO-SVS and DSO-HL decrease with statistical significance (Ps = 0.02 and 0.001, respectively). The distribution of the numbers of sphenopalatine foramen was as follows: one 90%, two 9.7%, and four 0.3%.
Conclusions: The horizontal distance between the SVS and the sphenopalatine foramen plays a significant role in identifying the location of sphenoid sinus ostium. As with the other landmarks, the SVS provides an additional benefit in locating the sphenoid sinus ostium for endoscopic sinus surgeons. The incidence of 4 sphenopalatine foramen is 0.3%.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00062http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Location_of_Facial_Foramina_and_Mandibular_Angle.63.aspx
Purpose: The current study’s purpose was to determine morphometric analysis of all facial foramina and mandibular angle relative to surgical landmarks from cone beam computed tomographic scans.
Materials and Methods: Three-dimensional computed tomographic scans were reconstructed from data of 100 patients (200 sides) aged between 19 and 76 years. Morphometric measurements of all facial foramina relative to surgical landmarks were taken. Mandibular angle was measured.
Results: There was no statistically significant difference between the left and right sides for all parameters (P > 0.05). Therefore, we found bilateral symmetry in the position of all facial foramina and mandibular angle. However, statistically significant differences were determined in sexes in some of these parameters and mandibular angle.
Conclusions: The knowledge about locations of facial foramina and mandibular angle is important for performing local nerve block and surgery in the face to avoid the neurovascular structures. This study provides a guideline for locations of facial foramina and mandibular angle, which may help surgeons to understand the nerve location precisely during surgery.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00063http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Frequency_of_Existence,_Numbers,_and_Location_of.64.aspx
Abstract: The aim of this study is to analyze the frequency of existence, numbers, and location of the accessory infraorbital foramen (AIOF).
In a PubMed search, 166 articles resulted using the term infraorbital foramen (IOF). The abstracts were read, and 15 full-text articles were reviewed. Among them, 13 articles were analyzed.
The frequency of the skull containing the AIOF varied (0.8%–27.3%). The overall frequency of the skull having AIOF was 16.9% ± 8.6% (17.0% ± 9.4% in dry skulls and 15.8% ± 3.6% in cadavers). Most (92.2%) of the AIOF were located on the superomedial side of the IOF, whereas 5 (7.8%) were located inferomedially. The AIOFs were found in similar frequency according to the laterality (right, 42.7%; left, 45%; bilateral, 12%; P = 0.794 [binominal test]). The frequency of the AIOF varied according to latitude. Skulls collected greater than 60 degrees had a higher frequency of an AIOF (28.7%) than between 30 and 60 degrees (19.0%) or less than 30 degrees (18.2%) (P = 0.000 [Pearson Chi-squared test], P = 0.000 [trend test]). There was a positive correlation between latitude and frequency of AIOF (y = 0.062x + 18.02, Pearson correlation coefficient = 0.140, P = 0.000).
During anesthetization of the infraorbital area or in surgical maneuvering in the maxillofacial region, surgeons should remember the frequency of the AIOF (16.9% ± 8.6%) and its location (92.2% at the superomedial side of the IOF).]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00064http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Effect_of_Coenzyme_Q10_on_the_Regeneration_of.65.aspx
Objective: The aim of this study is to show the possible positive effect of coenzyme Q10 (Co Q10) on regenerating in facial palsy.
Materials and Methods: Sixteen female Sprague-Dawley albino rats were randomly divided into 2 groups as Co Q10 and control groups. Group Q10 (n = 8) received Co Q10 of 10 mg/kg/d intraperitoneally for 30 days, and group C (n = 8) received saline solution of 1 mL/d intraperitoneally once daily for 30 days. The right facial nerve stimulation thresholds were determined before crush, immediately after crush, and after 1 month.
After determination of the thresholds, the crushed part of the facial nerve was then excised. All specimens were examined by a pathologist using a light microscope.
Results: No statistically significant difference in stimulation threshold was found between the Co Q10 and saline groups after crushing (P = 0.645). After 1 month of treatment, stimulation thresholds were significantly lower in both the Co Q10 and saline groups (Ps = 0.028 and 0.016). However, the Co Q10 group showed greater improvement than the saline group (P = 0.050).
After 1 month of treatment, neither the Co Q10 group nor the saline group had reached the precrushing amplitude levels (Ps = 0.027 and 0.011).
Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the Co Q10 and control groups by light microscopy (P < 0.05).
Conclusions: Although many treatment methods have been tried to accelerate facial nerve regeneration after trauma, a definitive method has not been found yet. Co Q for the treatment of acute facial paralysis is promising on both physiologic assessments and pathologic evaluation.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00065http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Correlation_of_the_Clinical_and_In_Vitro.66.aspx
Abstract: Absorbable internal fixation devices have built a successful clinical history in a variety of applications throughout the skeleton. Their appeal lies in their ability to lose strength and mass in a predictable reproducible manner, consistent with the healing process. Most of the evidence for their degradation properties, however, is derived from in vitro and animal studies. These methods approximate only the human clinical condition, and there are few such data available directly from patients. To better understand the absorption profile of an 85:15 poly(l-lactic acid):poly(glycolic acid) copolymer in humans, a “mini meta-analysis” was performed on 2 published studies: (1) a clinical study that followed reduction in CT image density of a cross-pin for ligament reconstruction over a 2-year interval, and (2) an in vitro study that measured the hydrolysis and strength loss of test specimens over a 10- to 11-month interval in a phosphate-buffered saline at 37°C. The CT image density profile grossly approximated the in vitro tensile modulus profile with both quantities retaining at least half of their initial value at 44 to 52 weeks, but bore little resemblance to the rapid decreases in inherent viscosity (a measure of average molecular weight) and elongation to break (a measure of ductility), which were at half their initial values by 32 to 36 weeks. Because of the inherent difficulty in directly measuring absorbable implant degradation in patients on a routine basis, investigators should seize opportunities such as this in an effort to close the knowledge gap regarding absorbable implant degradation in humans as much as possible.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00066http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Functional_and_Histopathologic_Change_in_the.67.aspx
Aims: The aim of this study was to evaluate the functional and histopathologic changes in the levator palpebrae superioris and Müller muscles after subconjunctival injection of triamcinolone acetonide (TA) in rabbits.
Methods: Twenty-four white New Zealand rabbits were divided into 2 groups. In group A, a subconjunctival injection of 0.5 mL TA (40 mg/mL) was administered to the right eye, whereas a normal saline injection of the same volume was administered to the left eye. In group B, the same procedures were done with a 1.0-mL injection of TA or normal saline into each eyelid. Follow-up was done to evaluate the histopathologic changes in the levator and Müller muscles, changes in the mean transectional area of Müller muscle, and changes in upper-lid height (marginal reflex distance 1) at 1, 2, 4, and 6 weeks after injection. Western blot analyses were used to determine the levels of myosin light chain phosphorylation and α-smooth muscle actin, which are related to the contractility of Müller muscle.
Results: No specific changes in marginal reflex distance 1 were noted in either group A or B. No significant histopathologic changes were found in the levator muscles. However, significant thinning of Müller muscle were found, and myosin light chain phosphorylation and α-smooth muscle actin levels were decreased. This was consistent with the histologic changes of Müller muscle observed in rabbits that received a TA injection. These changes were reversible and influenced by the volume of the injection.
Conclusions: Subconjunctival injection of TA into the upper eyelids appears to be temporally influential on both the functional and histopathologic changes of Müller muscle in rabbits. This may be explained by the effect of improvement in lid retraction regardless of the minimal specific change observed in the levator muscle.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00067http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Effects_of_Nonvascularized_Versus_Vascularized.68.aspx
Abstract: It remains unknown whether bone graft vascularity influences calvarial healing. The purposes of this study were (1) to develop a model to study nonvascularized and vascularized calvarial grafts as well as (2) to compare effects of bone graft vascularity on calvarial healing. Bilateral calvarial defects were created in 26 Wistar rats. The defects were left empty within 1 parietal region. On the contralateral side, the defects were partially closed with native parietal bone (control group, n = 6), nonvascularized (N-V, n = 10), or vascularized bone grafts (VAS, n = 10). The vascularized grafts were supplied by perforating dural arterioles. Bone mineralization and healing patterns from serial microcomputed tomographic scans were compared within and across the groups using parametric and nonparametric tests. Differences in bone mineral content across sides were significant between the groups at weeks 6 (P = 0.016) and 12 (P = 0.025). Bone formation was greater within both the control and VAS groups versus the N-V group at weeks 6 and 12 (P < 0.05). Healing patterns differed between the groups (P < 0.05), progressing through islands of new bone formation within the control and VAS groups while limited to defect margins on the N-V graft side. In conclusion, a bilateral calvarial defect model was established to study bone graft vascularity. Bone quantity and healing patterns differed in the presence of the nonvascularized versus vascularized grafts. Although the calvarial defect model is often applied within the plastic surgery literature to study bone substitutes, greater understanding of basic mechanisms influencing calvarial healing is first needed to avoid confounding results.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00068http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Extraction_and_Measurement_of_Bone.69.aspx
Abstract: Bone morphogenetic proteins (BMPs), present in parts per billion in bone, endow demineralized bone matrix (DBM) with osteoinductive properties suitable for clinical use. Although BMPs are mainly associated with bone matrix, they also associate with other bone compartments as well, including the mineral phase. The purpose of this study was to gain a more complete understanding of the distribution of BMPs in undemineralized bone. Eleven discrete particle size ranges of bovine cortical bone were prepared, ranging between less than 25 μm and 600 to 710 μm for the smallest and largest sizes, respectively. The bone was extracted with 4-M guanidine-HCl/0.05-M Tris-HCl, and the amount of BMP-7 released was measured with enzyme-linked immunosorbant assay. In addition, 106- to 710-μm bone particles were demineralized and similarly extracted for comparison. The measured BMP-7 content of the DBM was 24.6 ± 1.56 ng/g. The values for bone increased nonlinearly with decreasing particle size, ranging from 1.13 ± 0.50 ng/g for the 600- to 710-μm particles to 4.18 ± 1.14 ng/g for the less than 25-μm particles (P < 0.001). However, modeling the bone particles as solid spheres to estimate total surface area showed that the extracted BMP-7 per unit area was greater for larger particle sizes. These seemingly opposing results suggest that BMPs may become proportionally damaged or altered in response to the increased forces required to generate smaller particles and, as such, may not be detectable with enzyme-linked immunosorbant assay. In addition, minimization of bone particle size is not an effective strategy to approach the BMP availability of DBM.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00069http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endogenous_Cell_Therapy_Improves_Bone_Healing.70.aspx
Background: Although bone repair is often a relatively rapid and efficient process, many bone defects do not heal. Because an adequate blood supply is essential for new bone formation, we hypothesized that augmenting new blood vessel formation by increasing the number of circulating vasculogenic progenitor cells (PCs) with AMD3100 and enhancing their trafficking to the site of injury with recombinant human parathyroid hormone (rhPTH) will improve healing.
Methods: Critical-sized 3-mm cranial defects were trephined into the right parietal bone of C57BLKS/J 6 mice (N = 120). The mice were divided into 4 equal groups (n = 30 for each). The first group received daily subcutaneous injections of AMD3100 (5 mg/kg). The second group received daily subcutaneous injections of rhPTH (5 mg/kg). The third group received both AMD3100 and rhPTH. The fourth group received subcutaneous injections of saline. Circulating vasculogenic PC numbers, new blood vessel formation, and bony regeneration were assessed. Progenitor cell adhesion, migration, and tubule formation were assessed in the presence of rhPTH and AMD3100.
Results: Flow cytometry demonstrated that combination therapy significantly increased the number of circulating PCs compared with all other groups. In vitro, AMD3100-treated PCs had significantly increased adhesion migration, and tubule formation was assessed in the presence of rhPTH. Combination therapy significantly improved new blood vessel formation in those with cranial defect compared with all other groups. Finally, bony regeneration was significantly increased in the combination therapy group compared with all other groups.
Conclusions: The combination of a PC-mobilizing and traffic-enhancing agent improved bony regeneration of calvarial defects in mice.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00070http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__A_Systematic_Review_of_the_Effects_of.71.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00071http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Are_We_Paying_Our_Housestaff_Fairly__.72.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00072http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Morning_Joe_or_After_Dinner_Espresso_.73.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00073http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of_It_Is_Time_to_Reevaluate_the_Management.74.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00074http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__The_Effects_of_Multiple_Mild_Traumatic.75.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00075http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Fifty_Years_at_the_Forefront_of_Ethical.76.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00076http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Assessment_of_Resident_Operative.77.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00077http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__The_Evolution_and_Future_of_Scientific.78.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00078http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Surgical_Management_of_Trigeminal.79.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00079http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__Quantifying_Innovation_in_Surgery__by.80.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00080http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Review_of__The_Use_of_Silk_Based_Devices_for.81.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00081http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Facial_Nerve_by_William_H__Slatterly_III_and.82.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00082http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Can_Platelet_Rich_Plasma_Enhance_Bone_Healing.83.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00083http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Late_Treatment_of_Ocular_Globe_Displacement_to_the.84.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00084http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Malignant_Peripheral_Nerve_Sheath_Tumor_of_the.85.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00085http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Oro_Nasal_Communication_Closure_in_Smoker_Patient.86.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00086http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Existence_of_and_Predisposing_Factors_for_Implant.87.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00087http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Concerning_the_Article__Neutrophil_Lymphocyte.88.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00088http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endoscopic_Sinus_Surgery_and_Intraoral_Approaches.89.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00089http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Brooke_Spiegler_Syndrome_Clinically_Misdiagnosed.90.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00090http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Hypoplastic_Mandibular_Labial_Frenulum_With.91.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00091http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Navigation_Aided_Endoscopic_Sinus_Surgery.92.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00092http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/A_Propranolol_Nonresponsive_Mass__.93.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00093http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Incidental_Findings_on_Preoperative_Computed.94.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00094http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Advanced_Marjolin_Ulcer_of_the_Scalp_With_Skull.95.aspx
No abstract available]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00095http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Izogenic_Cartilage_Transfer_in_Rhinoplasty.96.aspx
Abstract: Cartilage is commonly grafted during primary and secondary rhinoplasties as a means of addressing both functional and esthetic issues. Generally, such grafts are taken from the nasal septum, but auricular conchae or ribs may serve as donor sites if needed. However, the latter often entail considerable morbidity and graft mismatch. To circumvent these drawbacks, use of implants or processed cartilage (allogenic or xenogenic in origin) has been proposed. Herein, the isogenic transfer of nasal septal cartilage between identical twins is reported.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00096http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Management_of_a_Transcranial_Abscess_Secondary_to.97.aspx
Abstract: Interleukin-1 receptor associated kinase 4 (IRAK-4) deficiency is a primary immunodeficiency that predisposes to opportunistic pyogenic infections in affected patients. The presentation can be variable, and the microbiological and immunologic management of this condition has been documented; however, the atypical nature of its presentation calls for a different approach in its surgical management. This is the first reported case of transcranial progression of a soft tissue abscess in a patient with IRAK-4 deficiency, with an emphasis on a multidisciplinary approach to treat infection at an extremely vulnerable anatomic site.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00097http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Metastatic_Follicular_Thyroid_Carcinoma.98.aspx
Abstract: Skull-base metastasis is rarely reported in thyroid carcinoma. We are presenting an unusual interesting case mimicking metastatic renal cell carcinoma with intense clear cell morphology, the thyroid origin of which was detected via positron emission tomography/computerized tomography scan proposed by the oncology council, while we were monitoring the subject with the initial diagnosis of paranasal sinus tumor. A mass was detected in the left nasal cavity in the endoscopic examination of the 68-year-old female patient referred by the ophthalmology clinic with the preliminary diagnosis of retro-orbital tumor upon being admitted with proptosis. A soft tissue lesion at a size of 68 × 39 × 53 mm located intracranially was detected by the brain computerized tomography. The biopsy taken and the immunohistochemical results were not satisfactory. Intense fluorodeoxyglucose involvement was observed in both lobes of the thyroid gland at positron emission tomography/computerized tomography taken with the recommendation of the council. Moreover, hypermetabolic nodules were seen in both lung parenchyma areas, whereas intense hypermetabolic lytic lesions were observed in the skeletal system. Thyroglobulin and thyroid transcription factor 1 stains displayed a strong staining on paraffin block. On the basis of these characteristics, the case was regarded as compatible metastatic follicular thyroid carcinoma, with skull-base, cranial, retro-orbital, paranasal sinus, lung, and bone metastases. This case showed us that multidisciplinary work and assessment of the oncology council play a highly critical role in making the diagnosis and guiding the treatment.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00098http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Orbital_Trapdoor_Fracture___Can_It_Occur_Also_in.99.aspx
Abstract: We describe here a peculiar case of a 30-year-old woman presenting with an orbital trapdoor fracture. Preoperative and postoperative magnetic resonance images are provided to explain the mechanism of the injury.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00099http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Hybrid_Approach_for_Reconstruction_of_Severely.100.aspx
Background: Although silicone injections for permanent soft tissue augmentation were popular in the past, their use has become unduly controversial because of severe complications, mainly caused by injection of illegal silicones by unlicensed practitioners. The delicate local anatomy of the lower eyelid region makes this region particularly susceptible for complications after silicone augmentation including local inflammation, tissue retraction, and consecutive cicatricial ectropion leading to lagophthalmus and ocular surface irritation.
Clinical Report: This is a case of a 47-year-old patient demonstrating severe lower eyelid destruction with consecutive ectropion after injection of commercial grade silicone in Thailand 5 years prior, leading to chronic granulomatous infections requiring multiple surgical interventions.
Our hybrid approach included radical debridement with complete elimination of silicone residues, lateral canthopexy, reconstruction of the entire lower eyelid esthetic unit using a supraclavicular full-thickness skin graft, and temporary tarsorrhaphy followed by 2 sessions of autologous fat graft injections.
Although many previous publications mainly focus on individual aspects of lower eyelid reconstruction, we describe a staged reconstructive approach for correction of severely destructed lower eyelid defects with consecutive lower eyelid ectropion.
Conclusions: The hybrid approach presented here has proven to be a viable surgical strategy for lower eyelid reconstruction, with esthetically appealing results.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00100http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Treatment_of_Migration_and_Extrusion_of_the_Gold.101.aspx
Abstract: Gold weight implantation is generally considered a safe procedure for the treatment of paralytic lagophthalmos. The most frequently seen complications are extrusion, malpositioning, and migration of the implant. To decrease the rate of these complications, several modifications were defined in the composition and the shape of the implant as well as the surgical technique itself. Despite these precautions, implant revision rates are still as high as 8% to 14%. Nowadays, implant-covering or implant-wrapping procedures are becoming more popular to avoid implant-related problems. However, there is limited information in the literature regarding the management of these complications. In this study, we aimed to present the treatment of migration and extrusion of the gold weight implant in a patient with Moebius syndrome by wrapping the implant with autogenous fascia lata graft.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00101http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Chondroid_Syringoma_of_the_Nasal_Dorsum.102.aspx
Abstract: Chondroid syringoma (CS) is an uncommon cutaneous tumor in the head and neck, with reported incidence rate from 0.01% to 0.1%. The CS of skin is a rare type of soft tissue tumor originating from the sweat glands. We report a documented case of CS occurring in the nasal dorsum in a 58-year-old man, which developed during the course of 1 year. The clinical, gross pathologic, and histologic findings of the tumor are described. The lesion was totally excised via transcutaneous approach and showed no evidence of recurrence after excision.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00102http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Use_of_the_Buccal_Fat_Pad_as_Free_Graft_for.103.aspx
Abstract: Oronasal fistulas are frequent complications after cleft lip and palate surgery, with difficult treatment because of the presence of fibrotic and scarred tissue as well as the absence of local virgin tissue, representing a challenge in oral and maxillofacial surgery. The size of the fistula, its location, and the cause of the defect are important factors to determine the type of treatment and surgical technique. The use of pedicled buccal fat pad (BFP) for the repair of cleft palate has shown promising results, becoming a safe and effective method. On the other hand, the use of BFP as a free graft for oral defects has been rarely described in the literature. The current study is the first case report that shows the use of free graft of BFP in oronasal fistula after cleft lip and palate surgery and aimed to discuss the promising results of this surgical technique, suggesting it as a treatment option for anterior maxillary defects, when properly indicated.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00103http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Mandibular_Lengthening_by_Distraction_Osteogenesis.104.aspx
Abstract: Osteogenesis imperfecta (OI) is an inherited disorder characterized by bone fragility and deformity. The craniofacial skeleton may be involved either primarily or by result of a concomitant diagnosis. Distraction osteogenesis has emerged as a versatile reconstructive option for many craniofacial deformities. Mandibular lengthening by distraction has not been reported in a patient with OI. We present a patient in whom mandibular lengthening was successfully performed twice for hemifacial microsomia. Bilateral lengthening was initially performed with successful airway improvement. This was followed by transport distraction on the more severely affected side for condylar reconstruction. Successful mandibular lengthening by distraction is possible in the setting of OI.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00104http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/The_Use_of_a_Computed_Tomographic_Application_for.105.aspx
Abstract: The aim of the current technical report was to introduce a computed tomographic (CT) application for mobile devices as a diagnostic tool for analyzing CT images. An iPad and an iPhone (Apple, Cuppertino, CA) were used to navigate through multiplanar reconstructions of cone beam CT scans, using an application derived from the OsiriX CT software. Tools and advantages of this method were recorded. In addition, images rendered in the iPad were manipulated during dental implant placement and grafting procedures to follow up and confirm the implant digital planning in real time. The study population consisted of 10 patients. In all cases, it was possible to use image manipulation tools, such as changing contrast and brightness, zooming, rotating, panning, performing both linear and area measurements, and analyzing gray-scale values of a region of interest. Furthermore, it was possible to use the OsiriX application in the dental clinic where the study was conducted, to follow-up the analyzed implant placement and grafting procedures at the chairside. The current findings suggest that technological and practical methods to visualize radiographic images are invaluable resources to improve training, teaching, networking, and the performance of real-time follow-up of oral and maxillofacial surgical procedures. This article discusses the advantages and disadvantages of introducing this new technology in the clinical routine.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00105http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Comparison_of_Different_Administration_of_Ketamine.106.aspx
Objectives: Tonsillectomy is the oldest and most frequently performed surgical procedure practiced by ear, nose, and throat physicians. In this study, our aim was to compare the analgesic effects of peritonsillar, rectal, as well as intravenous infiltration of ketamine and intravenous tramadol hydrochloride infiltration for postoperative pain relief and sedation after tonsillectomy in children.
Materials and Methods: This randomized controlled study evaluated the effects of peritonsillar, intravenous, and rectal infiltration of ketamine in children undergoing adenotonsillectomy. One hundred twenty children who were categorized under American Society of Anesthesiologists classes I to II were randomized to 4 groups of 30 members each. Group 1 received intravenous (IV) ketamine (0.5 mg/kg), group 2 received rectal ketamine (0.5 mg/kg), group 3 received local peritonsillar ketamine (2 mg/kg), and the control group received IV tramadol hydrochloride infiltration (2 mg/kg). Children’s Hospital of Eastern Ontario Pain Scale scores and Wilson sedation scale were recorded at minutes 1, 15, 30, 60 as well as hours 2, 12, and 24 postoperatively. The patients were interviewed on the day after the surgery to assess the postoperative pain and sedation.
Results: All the routes of infiltration of ketamine were as effective as those of tramadol hydrochloride (P > 0.05). A statistically significant difference was observed between IV infiltrations and all groups during the assessments at hours 6 and 24. The analgesic efficacy of IV ketamine was found especially higher at hours 6 and 24 (P6 = 0.045, P24 = 0.011).
Conclusions: Perioperative, low-dose IV, rectal, or peritonsillar ketamine infiltration provides efficient pain relief without any adverse effects in children who would undergo adenotonsillectomy.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00106http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Modified_Fixation_of_Acrylic_Cranioplasty_in_the.107.aspx
Abstract: Cranioplasty can be performed using a number of materials ranging from autologous tissue to metallic or acrylic alloplastic implants. In this report, we present a unique case of revision cranioplasty in a patient with titanium allergy using a prefabricated, custom-made polymethylmethacrylate implant and a modified fixation technique without plates or screws.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00107http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endoscopic_Removal_of_Giant_Intranasal_Schwannoma.108.aspx
Abstract: Schwannoma is a benign neoplasm originating from schwann cells of the peripheral nerve sheath. Although nearly half of all schwannomas involve the head and neck region, nasal and paranasal sinus presentations are very rare in the literature. We present a case of nasal schwannoma originating from the right nasal cavity. A 59-year-old man presented with complaints of progressive right nasal obstruction and headache. Endoscopic examinations revealed a mass that filled the right middle meatus. At first glance, it was not like polyp tissue. Endoscopic sinus surgery was performed under general anesthesia, and the mass was completely removed.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00108http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Unilateral_Bone_Cavities_Situated_Near_the_Angle.109.aspx
Abstract: Stafne bone defects (SBDs) are asymptomatic radiolucent lingual/buccal bone lesions of the lower jaw and are frequently caused by soft tissue inclusion. These defects have a cystlike appearance on plain radiographs. The diagnosis of this defect is incidental because patients do not usually present clinical symptoms. The common variant of SBD exists at the third molar region of the mandible below the inferior alveolar canal. To date, only 1 case of multilocular SBD has been reported in the literature, including both clinical cases and archaeological specimens. The purpose of the current study was to describe a new case of multilocular appearance of SBD near the angle of the mandibula that was diagnosed with the aid of a three-dimensional cone beam computed tomographic scan.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00109http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/A_New_Surgical_Technique_of_Rhinophyma__Gull_Wing.110.aspx
Abstract: A variety of surgical techniques have been described for the treatment of rhinophyma. A case of severe rhinophyma was operated with a new surgical technique. The full-thickness excision was combined with the gull-wing incision in this technique. The patient was very satisfied with the result.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00110http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Branchiootorenal_and_Branchiooculofacial_Syndrome.111.aspx
Introduction: Branchiootorenal syndrome (BOR) is an autosomal dominant disorder. One of very similar syndromes is branchiooculofacial syndrome (BOF), with incomplete penetrance and variable expression. The overlap between BOR syndrome and BOF syndrome includes external ear abnormalities with hearing loss, lachrymal duct obstruction, branchial cleft remnants, and renal or urethral defects. The relationship between these 2 syndromes is still unclear.
Case Outline: We present 2 patients with these rare syndromes: a girl who has fulfilled the diagnostic criteria for BOR syndrome and a boy who has more than fulfilled the criteria for BOF syndrome. The diagnosis of BOF syndrome was performed only on the basis of clinical findings, without genetic confirmation.
Conclusions: Differential diagnosis between these similar syndromes with phenotypic variation is delicate especially without genetic examinations.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00111http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Video_Assisted_Resection_in_Benign_Frontal_Tumors.112.aspx
Abstract: Soft and osseous tumors that develop into the frontal are the most profitable with the use of video-assisted surgery, thus avoiding also a visible scar.
In the Department of Plastic Surgery at Argerich Hospital in Buenos Aires, Argentina, from 1999 to 2010, video-assisted operations were used in the treatment of 158 patients, 26 of them presented lipomas and osteomas into the frontal tissues.
In all 26 patients, both local anesthesia and incisions behind the hairline were performed.
Minor complications such as hematoma and transitory paresis of the frontal nerve were detected.
Video-assisted technique offered both good illumination and excellent magnification that not only permits a safe anatomic dissection by means of surgical maneuvers in avascular planes but also avoids visible scars.
The outcome achieved with endoscopic techniques has permitted to consider it like the first election in the surgical treatment in tumors developed into both soft and osseous tissues of the frontal area, offering more advantages than the classic approaches.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00112http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Fixation_of_Fractured_Inferior_Orbital_Wall_Using.113.aspx
Abstract: The objectives of surgical treatment for orbital fracture are to return soft tissue to its original position as well as reduce and fix the bone fragments properly. Reduction of the orbital bone through a subciliary or conjunctival incision and reduction using a urinary balloon catheter were simultaneously performed on 53 patients between 2010 and 2013. Fibrin glue was used to attach the reduced bone fragments. These patients had less than 2 cm2 of bone defect and showed diplopia, eye movement limitation, and enophthalmos. Diplopia, eye movement limitation, and enophthalmos were each reduced to 3/32, 2/25, and 2/48, respectively. There were no adverse effects, such as infection or hematoma, and because implants were not used, there was no possibility of its extrusion or foreign body reaction. The operation time decreased compared with when using an implant, and the bone fragments remained in a fixed position even after removing the urinary balloon catheter. Therefore, the use of fibrin glue proved to be effective in orbital floor fractures.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00113http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Osteoplastic_Flap_Approach_Versus_Orbitotomy_in.114.aspx
Abstract: A 44-year-old man developed a slow-growing painless left superolateral orbital mass that extended into the frontal sinus with a complaint of ptosis. Magnetic resonance imaging revealed a heterogenous hyperintense lesion confined to the left frontal bone and superior orbit. The osteoplastic frontal sinus approach was performed to drain supraorbital cholesterol granuloma cyst and for curetting the capsule. Orbitofrontal cholesterol granuloma characteristically arises in the diploe of the superolateral frontal bone. The traditional approach for a primarily orbitofrontal cholesterol granuloma is the transorbital approach including anterior orbitotomy or lateral orbitotomy.However, the osteoplastic approach should be kept in mind as an alternative aprroach for the management of supraorbital lesions in patients with well-pneumatized frontal sinus.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00114http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Sagittal_Split_Ramus_Osteotomy_for_Aneurysmal_Bone.115.aspx
Abstract: Aneurysmal bone cyst is a benign pseudocystic osseous lesion characterized by a fibrous connective tissue stroma with cellular fibrous tissue, multinucleated giant cells, and large blood-filled spaces with no endothelial lining. The entity is uncommon in facial bones, and it rarely involves the mandibular condyle. Resection of the lesion is the most accepted treatment. The present case is the 11th reported case of aneurysmal bone cyst of the mandibular condyle in the existing literature and the first where, rather than using conventional extra oral approach, sagittal split ramus osteotomy was used to excise the lesion successfully with no recurrence after 3 years of follow-up.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00115http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Simultaneous_Transsphenoidal_and_Transventricular.116.aspx
Abstract: The surgical management of giant pituitary adenomas is challenging. Although most pituitary adenomas, even those with suprasellar extension, can be resected using the transsphenoidal surgery alone, the transcranial approach is still needed for approximately 1% to 4% of these tumors. The transcranial approach is usually used in large adenomas with hourglass configuration and adenomas with firmconsistency impeding the adjunctive measures, which are used for delivering the suprasellar part of the tumor into the sellar area and thereby obscure the tumor resection by transsphenoidal route. In this report, we describe the successful use of transventricular endoscope as an adjunctive measure to remove giant pituitary adenoma from transsphenoidal route and discuss the limitations of this new technique. We concluded that this technique would be used safely in selected cases. Case selection and surgical strategies should be based on preoperative magnetic resonance imaging findings, ventricular size, and the availability of experienced surgeons.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00116http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Dandy_Walker_Syndrome_With_Severe_Velopharyngeal.117.aspx
Abstract: Dandy-Walker syndrome is a rare congenital brain deformation. Most symptoms are related with fourth ventricle and skull base malformations. Quite often, symptoms develop from infancy or progress rapidly. Cerebellar dysfunction, lack of muscle coordination, and skull deformities involving eye movement might be present. There are several Dandy-Walker syndrome complex types. We present a 23-year-old patient who had a severe dentofacial deformity with mandibular prognathism and extremely undeveloped maxillary bone resulting in palatopharyngeal and velopharyngeal dysfunction with complete lack of soft palate function resulting in increased speech tone and volume. Performing Le Fort I osteotomy in this case is greatly controversial and might result in even greater loss of function or even its total lack. Velopharyngeal complex is very important, and every surgeon should consider its value while planning Le Fort I osteotomies.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00117http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Neonatal_Mandibular_Distraction_in_a_Patient_With.118.aspx
Abstract: The purpose of this study was to analyze a case of mandibular distraction in a case of Treacher Collins syndrome. Mandibular distraction is an adequate surgical treatment of patients with Pierre Robin sequence and represents an alternative to tracheostomy. In severe hypoplastic cases or when three-dimensional vector control or gonial angle control is necessary, extraoral bidirectional or multidirectional devices have an advantage over intraoral devices. The anchorage obtained with transfixing Kirschner wires fixed in the mandibular distal segment and symphysis is crucial in neonates for the stability of the devices. Moreover, with the use of a second pin for each bone segment, the extraoral devices allow to modify the vector orientation and consequently the shape of the newly formed mandible.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00118http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Skin_Tension_Related_to_Tension_Reduction_Sutures.119.aspx
Abstract: The aim of this study was to compare the skin tension of several fascial/subcutaneous tensile reduction sutures. Six upper limbs and 8 lower limbs of 4 fresh cadavers were used. At the deltoid area (10 cm below the palpable acromion) and lateral thigh (midpoint from the palpable greater trochanter to the lateral border of the patella), and within a 3 × 6-cm fusiform area of skin, subcutaneous tissue defects were created. At the midpoint of the defect, a no. 5 silk suture was passed through the dermis at a 5-mm margin of the defect, and the defect was approximated. The initial tension to approximate the margins was measured using a tensiometer.
The tension needed to approximate skin without any tension reduction suture (S) was 6.5 ± 4.6 N (Newton). The tensions needed to approximate superficial fascia (SF) and deep fascia (DF) were 7.8 ± 3.4 N and 10.3 ± 5.1 N, respectively. The tension needed to approximate the skin after approximating the SF was 4.1 ± 3.4 N. The tension needed to approximate the skin after approximating the DF was 4.9 ± 4.0 N. The tension reduction effect of approximating the SF was 38.8 ± 16.4% (2.4 ± 1.5 N, P = 0.000 [ANOVA, Scheffé]). The tension reduction effect of approximating the DF was 25.2% ± 21.9% (1.5 ± 1.4 N, P = 0.001 [ANOVA, Scheffé]). The reason for this is thought to be that the SF is located closely to the skin unlike the DF. The results of this study might be a basis for tension reduction sutures.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00119http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Iatrogenic_Arteriovenous_Fistula_of_the.120.aspx
Abstract: A 34-year-old woman who had a history of undergoing reduction malarplasty at a local clinic about 1 year ago developed gradually increasing pulsatile tinnitus in the right preauricular area since the last 6 months. On physical examination, there were an approximately 1 × 0.5-cm nontender, soft, pulsatile mass with a palpable thrill and a continuous machinery-like buzzing sound in synchrony with the heartbeat. She had a fine scar near the mass, which was supposed to be a postoperative scar of reduction malarplasty. A three-dimensional computed tomographic angiogram revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in the right preauricular area. The arteriovenous fistula was embolized using Tornado coils. After coiling, the thrill and disturbing tinnitus disappeared immediately, and postembolization angiography confirmed obliteration of the arteriovenous shunt. This is the first case of an arteriovenous fistula of the superficial temporal artery after reduction malarplasty, and it indicates that arteriovenous fistula can occur as a delayed complication of reduction malarplasty.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00120http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Recurrent_Ptosis_in_a_Patient_With.121.aspx
Abstract: A 37-year-old woman presented with right upper eyelid blepharochalasis with ptosis. Right upper eyelid edema had occurred 2 to 3 times per year by 30 years old, although the frequency decreased with age. The edema occurred spontaneously and resolved within 1 to 2 days. She underwent a right levator tucking surgery at 22 years old, and the ptosis recurred 2 years postoperatively. She again underwent ptosis surgery with skin excision at 37 years old. The intraoperative findings showed a thin levator aponeurosis. The white line was therefore advanced to the upper tarsal edge, resulting in an appropriate height and curvature. Three months later, the patient’s eyelid height was 1.5 mm higher with a little temporal peaking. The levator aponeurosis was histopathologically shown to contain many capillaries. The increased vascularity of the levator aponeurosis may contribute to recurrent bouts of edema resulting in stretching and disinsertion of the aponeurosis.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00121http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Immediate_Reconstruction_of_the_Maxillary_Sinus.122.aspx
Abstract: We report a case of unicystic ameloblastoma associated with an ectopic third molar in the right maxillary sinus, which was misdiagnosed as a dentigerous cyst on preoperative small incisional biopsy. Surgical enucleation of the cystic lesion was performed under general anesthesia with immediate reconstruction of the maxillary sinus using titanium mesh plate. The patient’s postoperative recovery was uneventful, and there was no evidence of tumor recurrence during the 7-month follow-up period.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00122http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Robotic_Excision_of_a_Huge_Parathyroid_Adenoma_via.123.aspx
Abstract: Primary hyperparathyroidism results from the overproduction of parathyroid hormone by 1 or more autonomously hyperfunctioning parathyroid glands and often causes hypercalcemia. Once this condition has been diagnosed, the treatment of choice is surgical removal. There have been many attempts to remove the hyperfunctioning gland with minimally invasive surgical techniques, with cure rates comparable with those of conventional techniques. On the basis of our initial surgical experiences of robotic thyroidectomy and other head and neck surgeries via a retroauricular (RA) approach, we have recently successfully performed robotic excision of a huge parathyroid tumor via an RA approach on a 44-year-old woman who had been diagnosed with a parathyroid adenoma. It is the first to describe in detail the successful completion of a robotic parathyroidectomy via an RA approach.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00123http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Asymptomatic_Intradiploic_Epidermoid_Cyst_Eroding.124.aspx
Abstract: Epidermoid cyst located in cranium is uncommon and usually diagnosed with a growing mass leading to symptoms. Asymptomatic intradiploic epidermoid cyst has not been reported yet. In this study, incidental diagnosis of asymptomatic cyst and potential impact of that cyst on surgical planning of a patient with craniosynostosis are presented.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00124http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Completion_of_Nonreducible_Le_Fort_Fractures_by_Le.125.aspx
Abstract: The aim of this study was to prospectively evaluate the use of a simultaneous Le Fort I osteotomy for completion of nonreducible Le Fort fractures. We analyzed the clinical and radiological data of 44 patients with Le Fort fractures, 9 of whom presented with a nonreducible type. Seven patients with an incomplete Le Fort I fracture had a contralateral Le Fort I osteotomy, and 2 patients with an incomplete Le Fort III fracture had a true bilateral Le Fort I-type osteotomy. We recorded age and sex, mechanism of injury, level of Le Fort fracture, concomitant mandibular fractures, concomitant maxillomandibular fixation (MMF) and its duration, surgical approach, status of healing, and complications. Follow-ups were at 1 week and 1, 3, 6, and 12 months.
All patients recovered their normal pretrauma occlusion without the need for postoperative elastic guidance, except for 1 patient who required light class III traction elastics for 3 weeks to achieve the correct occlusion. None of the patients presented with intraoperative or postoperative complications.
The present study has demonstrated that completion of nonreducible Le Fort fractures by Le Fort I osteotomy results in a high rate of success.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00125http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Cranial_Base_Deviation_in_Hemifacial_Microsomia_by.126.aspx
Abstract: Although facial asymmetry in hemifacial microsomia (HFM) is well documented in the literature, no studies have concentrated on the morphology of the cranial base. This study aimed to evaluate the endocranial morphology in patients with HFM. Consecutive patients with unilateral HFM treated at a craniofacial center from 2000 to 2012 were included. The patients were grouped according to severity on the basis of the Kaban-Pruzansky classification: mild (0–1), moderate (2a), and severe (2b–3). Skull base angulation and transverse craniometric measures were recorded and then compared with those of age-matched controls.
A total of 30 patients (14 males, 16 females) averaging 7.5 years of age (range, 1.1–15.7 y) were included. Four patients were classified as mild; 12, as moderate; and 14, as severe. The mean cranial base angle was found to be between 179 and 181 degrees with no significant difference between the severity groups (P = 0.57). The mean cranial base angle did not differ significantly in the patients compared with the controls(179.6 vs 180.0; P = 0.51) No significant differences between the affected and unaffected sides in the patients were found in distances from the midline to hypoglossal canal, internal acoustic meatus, lateral carotid canal, medial carotid canal, foramen ovale, and rotundum. There were no significant differences in transverse measurements between the severity classes using the same landmarks (P = 0.46, P = 0.30, P = 0.40, P = 0.25, P = 0.57, and P = 0.76, respectively). The cranial base axis is not deviated in the patients with HFM compared with the age-matched controls, and there exists little difference in endocranial morphologic measurements with increasing severity of HFM. These data are interesting, given the role of the cranial base in facial growth and the varying hypotheses regarding the mechanism of disease in HFM.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00126http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Computed_Tomography_Image_Guidance_for_More.127.aspx
Background: Anterior table frontal sinus fractures accompanied by nasofrontal duct injury require surgical correction. Extracranial approaches for anterior table osteotomies have traditionally used plain radiograph templates or a “cut-as-you-go” technique. We compared these methods with a newer technique utilizing computed tomography (CT)–guided imaging.
Methods: Data of patients with acute, traumatic anterior table frontal sinus fractures and nasofrontal duct injury between 2009 and 2013 were reviewed (n = 29). Treatment groups compared were as follows: (1) CT image guidance, (2) plain radiograph template, and (3) cut-as-you-go. Frontal sinus obliteration was performed in all cases. Demographics, operative times, length of stay, complications, and osteotomy accuracy were recorded.
Results: Similar demographics, concomitant injuries, operative times, and length of stay among groups were noted. No patients in the CT-guided group had perioperative complications including intraoperative injury of the dura, cerebrum, or orbital structures. In the plain radiograph template group, 25% of patients had inadvertent dural exposure, and 12.5% required take-back to the operating room for cranial bone graft donor site hematoma. In the cut-as-you-go group, 11% required hardware removal for exposure. There were no cases of cerebrospinal fluid leak, meningitis, or mucocele in any group (follow-up, 29.2 months). The CT image guidance group had the most accuracy of the osteotomies (95%) compared with plain radiograph template (85%) and the cut-as-you-go group (72.5%).
Conclusions: A new technique using CT image guidance for traumatic frontal sinus fractures repair offers more accurate osteotomy and elevation of the anterior table without increased operative times or untoward sequelae.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00127http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Congenital_Maxillomandibular_Syngnathia___A_New.128.aspx
Abstract: Complex zygomaticomandibular syngnathia is an extremely rare condition with an unknown etiology. The main goal of the surgery is to release the ankylosis, establish good functioning mandible, and prevent reankylosis, if possible. In our case, we offer a new solution to have an adequate oral opening and to prevent reankylosis. After the release of bony syngnathia, we placed a distractor between mandibular segment and maxillozygomatic complex. To our best knowledge, this is the only syngnathia case in the literature treated using distraction techniques. There is a major improvement in the patient’s status. Distraction may broaden our horizons in this rare and difficult-to-treat deformity.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00128http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Posterior_Cranial_Vault_Distraction_in_the.129.aspx
Abstract: Cerebrospinal fluid shunt placement is the most common surgical intervention for hydrocephalus. In rare cases, cerebrospinal fluid shunting has been associated with the development of secondary craniosynostosis. Posterior cranial vault distraction osteogenesis is an emerging technique used for the treatment of craniosynostosis. Posterior vault distraction allows greater intracranial volume expansion than do techniques that address the anterior cranium. We present a patient with shunt-induced multisuture craniosynostosis with delayed presentation. She was effectively treated with posterior cranial vault distraction and preservation of her ventriculoperitoneal shunt. This unique case demonstrates the safety and utility of this procedure for complex craniocerebral disproportion.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00129http://journals.lww.com/jcraniofacialsurgery/Fulltext/2015/01000/Endoscopic_Marsupialization_of_Frontoethmoid.130.aspx
Abstract: Fibrous dysplasia (FD) is a benign progressive fibro-osseous lesion that is rarely associated with mucocele formation. This complication most probably results from the involvement and subsequent occlusion of the recesses of the sinuses by the dysplastic process. The frontoethmoid mucocele associated with FD represents a rare pathology, but it is important to consider this in the differential diagnosis of patients with proptosis, visual disturbance, and bony fronto-orbital swellings. Here, we describe the first case of frontoethmoid mucocele with underlying craniofacial FD, which was successfully treated by wide marsupialization via the transnasal endoscopic approach.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000001665-201501000-00130